MEDICARE: MR. KENDALL YAZZIE REDHORSE CHAMBELLAN PA

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	363A00000X	Physician Assistant	PA 01658	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	794785	OTHER	TX	MEDICARE
2	P02237142	OTHER	TX	MEDICARE RAIL ROAD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1861498768
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. KENDALL YAZZIE REDHORSE CHAMBELLAN PA

Provider Business Mailing Address
First Line	:	PO BOX 846098
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75284-6098
Country	:	US
Telephone Number	:	903-324-6400
Fax Number	:

Provider Business Practice Location Address
First Line	:	811 S WASHINGTON AVE
Second Line	:
City	:	MARSHALL
State	:	TX
Zip	:	75670
Country	:	US
Telephone Number	:	903-315-1488
Fax Number	:

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

Provider Enumeration Date	:	06/24/2005
Last Update Date	:	03/26/2024

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Directions to “ MR. KENDALL YAZZIE REDHORSE CHAMBELLAN PA” Practice Location

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