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General NPI Number Information
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NPI Number | 1619635067
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Entity Type | Individual
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Provider Name | CHAYSE JACKSON PA-C
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Gender | Female
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Dates
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Enumeration Date | 12/02/2021
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Last Update Date | 04/20/2023
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Provider Practice Location Address
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Address Line | 3417 GASTON AVE STE 760
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City | DALLAS
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State | TX
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Zip | 75246-2031
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Country | US
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Telephone | 214-369-1907
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Fax |
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Provider Business Mailing Address
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Address Line | 8315 MACGREGOR DR
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City | ARLINGTON
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State | TX
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Zip | 76002-4239
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Country | US
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Telephone | 419-722-0914
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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 |
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License Number State |
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