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NPI 1629549498

NPI 1629549498 : ANCY KURIAN CHEMPOLA PA-C : GRAPEVINE, TX

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General NPI Number Information
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    NPI Number           |    1629549498
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    Entity Type          |    Individual 
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    Provider Name        |    ANCY KURIAN CHEMPOLA PA-C
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    Gender               |    Female 
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Dates
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    Enumeration Date     |    12/05/2018
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    Last Update Date     |    08/05/2025
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Provider Practice Location Address
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    Address Line         |    3801 WILLIAM D TATE AVE STE 840 
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    City                 |    GRAPEVINE
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    State                |    TX
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    Zip                  |    76051-8759
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    Country              |    US
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    Telephone            |    817-310-3772
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    Fax                  |    817-310-3950
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Provider Business Mailing Address
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    Address Line         |    2040 E STATE HIGHWAY 121 APT 5014 ANCYCHEMPOLA@TEXASHEALTH.ORG
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    City                 |    LEWISVILLE
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    State                |    TX
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    Zip                  |    75056
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    Country              |    US
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    Telephone            |    646-761-4704
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    Fax                  |    817-310-3950
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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       |    022898
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    License Number State |    NY
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Taxonomy #2
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    Taxonomy Code        |    363A00000X
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    Taxonomy Name        |    Physician Assistant
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    License Number       |    PA19207
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    License Number State |    TX
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