Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2100X | Nurse Practitioner - Acute Care | 713739 | TX |
N | 363LF0000X | Nurse Practitioner - Family Medicine | 713739 | TX |
N | 363LP2300X | Nurse Practitioner - Primary Care | 713739 | TX |
NPI | 1083944185 |
---|---|
Provider Name | Mr. Michael Jason Chastant |
First Address | Whitehouse, TX 75791-3109 |
Second Address | Whitehouse, TX 75791-3109 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/01/2010 |
Last Update Date | 10/09/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1083944185 | BCBSTX (01) | TX |
3470247-01 | (05) | TX |
836N74 | BCBSTX (01) | TX |
P01436330 | RR MEDICARE (01) | TX |