Provider Demographics
NPI:1114238672
Name:CHAPPELL, KURT A
Entity Type:Individual
Prefix:MR
First Name:KURT
Middle Name:A
Last Name:CHAPPELL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4736 BRYANT IRVIN RD STE 702
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76132-3640
Mailing Address - Country:US
Mailing Address - Phone:817-263-1971
Mailing Address - Fax:817-263-2365
Practice Address - Street 1:4736 BRYANT IRVIN RD STE 702
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76132-3640
Practice Address - Country:US
Practice Address - Phone:817-263-1971
Practice Address - Fax:817-263-2365
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-29
Last Update Date:2010-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX50084237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX50084OtherLICENSE