Provider Demographics
NPI:1073127080
Name:REYESMCCHESNEY, THELMA IVY (PNP)
Entity Type:Individual
Prefix:
First Name:THELMA
Middle Name:IVY
Last Name:REYESMCCHESNEY
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:163 VILLAGE EAST DR
Mailing Address - Street 2:
Mailing Address - City:LOS FRESNOS
Mailing Address - State:TX
Mailing Address - Zip Code:78566-3104
Mailing Address - Country:US
Mailing Address - Phone:956-254-6089
Mailing Address - Fax:
Practice Address - Street 1:163 VILLAGE EAST DR
Practice Address - Street 2:
Practice Address - City:LOS FRESNOS
Practice Address - State:TX
Practice Address - Zip Code:78566-3104
Practice Address - Country:US
Practice Address - Phone:956-254-6089
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-07
Last Update Date:2020-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1011628363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics