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General NPI Number Information
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NPI Number | 1427127638
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Entity Type | Individual
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Provider Name | THERESA CHADWICK PA-C
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Gender | Female
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Dates
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Enumeration Date | 11/06/2006
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Last Update Date | 08/10/2011
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Provider Practice Location Address
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Address Line | 409 COTTAGE RD
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City | CARTHAGE
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State | TX
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Zip | 75633-1466
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Country | US
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Telephone | 903-693-3841
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Fax | 903-694-4633
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Provider Business Mailing Address
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Address Line | 409 COTTAGE RD
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City | CARTHAGE
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State | TX
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Zip | 75633-1466
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Country | US
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Telephone | 903-693-3841
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Fax | 903-694-4661
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA01697
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License Number State | TX
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