MEDICARE: CHAD ALLEN BINGHAM I APRN, PMHNP-BC

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	364SP0807X	Child & Adolescent Psychiatric/Mental Health Clinical Nurse Specialist	1141845	TX

General Provider Information

NPI Number	:	1790553733
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHAD ALLEN BINGHAM I APRN, PMHNP-BC

Provider Business Mailing Address
First Line	:	164 TWIN OAKS DR
Second Line	:
City	:	WACO
State	:	TX
Zip	:	76705-5219
Country	:	US
Telephone Number	:	903-875-8140
Fax Number	:

Provider Business Practice Location Address
First Line	:	3501 N 19TH ST
Second Line	:
City	:	WACO
State	:	TX
Zip	:	76708-2097
Country	:	US
Telephone Number	:	254-756-2171
Fax Number	:

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

Provider Enumeration Date	:	12/19/2023
Last Update Date	:	12/19/2023

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