Provider Demographics
NPI:1205025160
Name:CHES, NICOLE DIANE (PAC)
Entity Type:Individual
Prefix:MS
First Name:NICOLE
Middle Name:DIANE
Last Name:CHES
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 BINZ ST STE 580
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77004-6947
Mailing Address - Country:US
Mailing Address - Phone:281-758-2695
Mailing Address - Fax:833-272-9433
Practice Address - Street 1:1200 BINZ ST STE 580
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77004-6947
Practice Address - Country:US
Practice Address - Phone:281-758-2695
Practice Address - Fax:833-272-9433
Is Sole Proprietor?:No
Enumeration Date:2007-10-17
Last Update Date:2020-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA07267363A00000X, 363AM0700X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX598578YP67OtherMEDICARE PIN
TX328627002Medicaid
TXTXB128365OtherMEDICARE PTAN
TX559453YPNGMedicare PIN
TX559454YL0GMedicare PIN
TXTXB128365OtherMEDICARE PTAN