MEDICARE: CHELSEA T SPEER PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	088750	IA
2	363A00000X	Physician Assistant	PA15912	TX

General Provider Information

NPI Number	:	1609394964
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHELSEA T SPEER PA-C

Provider Business Mailing Address
First Line	:	909 MAIN ST
Second Line	:
City	:	BASTROP
State	:	TX
Zip	:	78602-3809
Country	:	US
Telephone Number	:	512-957-9638
Fax Number	:	512-233-5240

Provider Business Practice Location Address
First Line	:	909 MAIN ST
Second Line	:
City	:	BASTROP
State	:	TX
Zip	:	78602-3948
Country	:	US
Telephone Number	:	512-957-9638
Fax Number	:	512-233-5240

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/06/2017
Last Update Date	:	02/20/2026

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Directions to “ CHELSEA T SPEER PA-C” Practice Location

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