Provider Demographics
NPI:1154333870
Name:CHESSON, FONDA R (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:FONDA
Middle Name:R
Last Name:CHESSON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:723 HILL COUNTRY DR
Mailing Address - Street 2:SUITE C
Mailing Address - City:KERRVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78028-5904
Mailing Address - Country:US
Mailing Address - Phone:210-383-2373
Mailing Address - Fax:830-896-2625
Practice Address - Street 1:723 HILL COUNTRY DR
Practice Address - Street 2:SUITE C
Practice Address - City:KERRVILLE
Practice Address - State:TX
Practice Address - Zip Code:78028-5904
Practice Address - Country:US
Practice Address - Phone:210-383-2373
Practice Address - Fax:830-896-2625
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-12
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA03144363A00000X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX377756ZJHHMedicare PIN
TX8137873Medicare ID - Type Unspecified