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General NPI Number Information
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NPI Number | 1114419462
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Entity Type | Individual
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Provider Name | JOANN CHACKO SAMUEL PA-C
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Gender | Female
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Dates
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Enumeration Date | 06/02/2018
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Last Update Date | 01/30/2026
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Provider Practice Location Address
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Address Line | 2251 FM 646 RD W STE 155
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City | DICKINSON
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State | TX
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Zip | 77539-3256
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Country | US
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Telephone | 281-614-2445
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Fax |
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Provider Business Mailing Address
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Address Line | 106 SANDSTONE BEND LN
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City | DICKINSON
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State | TX
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Zip | 77539-4445
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Country | US
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Telephone | 832-285-7097
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA12399
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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