Healthcare Provider Details

I. General information

NPI: 1578275632
Provider Name (Legal Business Name): SHAUNTEEL L CHALK CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/21/2022
Last Update Date: 03/19/2024
Certification Date: 03/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4000 GARTH RD STE 200
BAYTOWN TX
77521-3169
US

IV. Provider business mailing address

1200 BINZ ST STE 1490
HOUSTON TX
77004-6946
US

V. Phone/Fax

Practice location:
  • Phone: 281-886-7566
  • Fax:
Mailing address:
  • Phone: 713-512-7700
  • Fax: 240-696-1353

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number941010
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number1102085
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: