Healthcare Provider Details

I. General information

NPI: 1689784274
Provider Name (Legal Business Name): BERNITA GALLAGHER CHANCE RNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 06/28/2023
Certification Date: 06/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2928 N BELT LINE RD
IRVING TX
75062-5247
US

IV. Provider business mailing address

PO BOX 132795
THE WOODLANDS TX
77393-2795
US

V. Phone/Fax

Practice location:
  • Phone: 214-307-7786
  • Fax:
Mailing address:
  • Phone: 936-273-2016
  • Fax: 936-273-2018

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number666037
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: