Provider Demographics
NPI:1114127248
Name:BOONE, CHANTELLE P (ARNP)
Entity Type:Individual
Prefix:
First Name:CHANTELLE
Middle Name:P
Last Name:BOONE
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:CHANTELLE
Other - Middle Name:P
Other - Last Name:COOK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:1011 N GALLOWAY AVE
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75149-2433
Mailing Address - Country:US
Mailing Address - Phone:214-320-7190
Mailing Address - Fax:
Practice Address - Street 1:1011 N GALLOWAY AVE # A2
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75149-2433
Practice Address - Country:US
Practice Address - Phone:214-320-7000
Practice Address - Fax:580-248-1725
Is Sole Proprietor?:No
Enumeration Date:2007-07-18
Last Update Date:2023-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP125560363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200124110AMedicaid
OK200124110AMedicaid
N/AMedicare UPIN