Healthcare Provider Details

I. General information

NPI: 1922491059
Provider Name (Legal Business Name): VIRGINIA CHACON NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/13/2015
Last Update Date: 05/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13155 S LAUPPE RD
YODER CO
80864-9724
US

IV. Provider business mailing address

2101 CHATALET LN APT I
PUEBLO CO
81005-2657
US

V. Phone/Fax

Practice location:
  • Phone: 719-478-2095
  • Fax:
Mailing address:
  • Phone: 719-252-1239
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPN.0991632-NP
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code364SP0813X
TaxonomyGeropsychiatric Psychiatric/Mental Health Clinical Nurse Specialist
License NumberAPN 0991632NP
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: