Provider Demographics
NPI:1174648430
Name:CHILES, JOHN HENRY (CRNA)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:HENRY
Last Name:CHILES
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 COUNTY ROAD 42400
Mailing Address - Street 2:
Mailing Address - City:PARIS
Mailing Address - State:TX
Mailing Address - Zip Code:75462-1409
Mailing Address - Country:US
Mailing Address - Phone:903-785-7258
Mailing Address - Fax:
Practice Address - Street 1:820 CLARKSVILLE ST
Practice Address - Street 2:
Practice Address - City:PARIS
Practice Address - State:TX
Practice Address - Zip Code:75460-6027
Practice Address - Country:US
Practice Address - Phone:903-785-4521
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX233238367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered