Healthcare Provider Details

I. General information

NPI: 1558113332
Provider Name (Legal Business Name): CHLOE NOELLE BEQUILLARD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2024
Last Update Date: 04/08/2024
Certification Date: 04/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 CUT OFF RD
PORT ARANSAS TX
78373-4245
US

IV. Provider business mailing address

13766 THREE FATHOMS BANK DR
CORPUS CHRISTI TX
78418-6351
US

V. Phone/Fax

Practice location:
  • Phone: 361-749-1930
  • Fax:
Mailing address:
  • Phone: 423-489-2692
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1004796
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: