Healthcare Provider Details

I. General information

NPI: 1780108175
Provider Name (Legal Business Name): CHELSEA BOHAC AGNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2017
Last Update Date: 03/25/2022
Certification Date: 03/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2039 N. MASON ROAD SUITE 601
KATY TX
77449
US

IV. Provider business mailing address

2039 N. MASON RD. UNIT 601
KATY TX
77449-6878
US

V. Phone/Fax

Practice location:
  • Phone: 713-589-3775
  • Fax:
Mailing address:
  • Phone: 713-589-3775
  • Fax: 713-589-3478

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAP134442
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: