Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | 659356 | TX |
NPI | 1013398767 |
---|---|
Provider Name | Brenda Chesley |
First Address | Amarillo, TX 79102-2224 |
Second Address | Amarillo, TX 79106-1787 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/06/2015 |
Last Update Date | 11/03/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
AP126985 | LICENSE (01) | TX |