Provider Demographics
NPI:1073804944
Name:CHACKO, JISHA CHERIAN (RN, MSN, NP-C)
Entity Type:Individual
Prefix:
First Name:JISHA
Middle Name:CHERIAN
Last Name:CHACKO
Suffix:
Gender:F
Credentials:RN, MSN, NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4206 N I 35
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76207-3441
Mailing Address - Country:US
Mailing Address - Phone:940-382-6900
Mailing Address - Fax:940-383-2224
Practice Address - Street 1:4206 N I 35
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76207-3441
Practice Address - Country:US
Practice Address - Phone:940-382-6900
Practice Address - Fax:940-382-1005
Is Sole Proprietor?:No
Enumeration Date:2011-04-27
Last Update Date:2022-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX712285363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily