Healthcare Provider Details

I. General information

NPI: 1700316726
Provider Name (Legal Business Name): THRESIAMMA K CHACKO NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2017
Last Update Date: 10/07/2024
Certification Date: 10/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 E TORONTO AVE
MCALLEN TX
78503-1209
US

IV. Provider business mailing address

PO BOX 531968
HARLINGEN TX
78553-1968
US

V. Phone/Fax

Practice location:
  • Phone: 956-296-3990
  • Fax: 956-665-6836
Mailing address:
  • Phone: 833-887-4863
  • Fax: 956-296-6842

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP131168
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: