Healthcare Provider Details

I. General information

NPI: 1811412992
Provider Name (Legal Business Name): MICHAEL CHANCE HULSEY AGACNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2017
Last Update Date: 08/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1441 N BECKLEY AVE
DALLAS TX
75203-1201
US

IV. Provider business mailing address

1401 STRATFORD LN
DENTON TX
76209-8201
US

V. Phone/Fax

Practice location:
  • Phone: 214-947-8181
  • Fax:
Mailing address:
  • Phone: 940-389-1398
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberAP134456
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: