MEDICARE: MS. BARBARA LOUISE CHANCEY RN

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
1	163W00000X	Registered Nurse	500112	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	08059485	OTHER	TX	DRIVERS LICENSE

General Provider Information

NPI Number	:	1235611948
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. BARBARA LOUISE CHANCEY RN

Provider Business Mailing Address
First Line	:	7604 NATALIE DR
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76134-4628
Country	:	US
Telephone Number	:	817-682-6588
Fax Number	:

Provider Business Practice Location Address
First Line	:	7604 NATALIE DR
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76134-4628
Country	:	US
Telephone Number	:	817-682-6588
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/30/2018
Last Update Date	:	08/30/2018

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