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NPI Code Detail

MEDICARE: RONY THANNIMOOTTILCHIRAYIL CHACKO AGACNP-BC

MEDICARE: RONY THANNIMOOTTILCHIRAYIL CHACKO AGACNP-BC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LA2200XAdult Health Nurse Practitioner1141167TX
2363LG0600XGerontology Nurse Practitioner1141167TX
3363LA2100XAcute Care Nurse Practitioner1141167TX

General Provider Information

NPI Number : 1215707567
Entity Type Code : Individual
Provider Name (Legal Business Name) : RONY THANNIMOOTTILCHIRAYIL CHACKO AGACNP-BC
Provider Business Mailing Address
First Line : 4025 BASHFUL DR
Second Line :
City : PLANO
State : TX
Zip : 75093-6977
Country : US
Telephone Number : 469-866-2643
Fax Number :
Provider Business Practice Location Address
First Line : 1001 RAINTREE CIR
Second Line :
City : ALLEN
State : TX
Zip : 75013-4912
Country : US
Telephone Number : 972-908-2000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/08/2024
Last Update Date : 01/08/2024

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