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General NPI Number Information
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NPI Number | 1083550834
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Entity Type | Individual
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Provider Name | GRACE BLOSSOM CHACKO NP
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Gender | Female
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Dates
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Enumeration Date | 04/24/2026
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Last Update Date | 04/24/2026
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Provider Practice Location Address
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Address Line | 23920 KATY FWY STE 510
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City | KATY
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State | TX
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Zip | 77494-0882
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Country | US
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Telephone | 832-605-7123
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Fax |
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Provider Business Mailing Address
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Address Line | 10425 HUFFMEISTER RD STE 280
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City | HOUSTON
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State | TX
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Zip | 77065-3430
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Country | US
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Telephone | 832-605-7123
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | 1193364
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License Number State | TX
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