Provider Demographics
NPI:1316212491
Name:MCHARGUE, BETTY FAKHRI (LSA)
Entity Type:Individual
Prefix:MRS
First Name:BETTY
Middle Name:FAKHRI
Last Name:MCHARGUE
Suffix:
Gender:F
Credentials:LSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3201 E PRESIDENT GEORGE BUSH HWY STE 101
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75082-3565
Mailing Address - Country:US
Mailing Address - Phone:972-470-5859
Mailing Address - Fax:972-470-5861
Practice Address - Street 1:3201 E PRESIDENT GEORGE BUSH HWY STE 101
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75082-3565
Practice Address - Country:US
Practice Address - Phone:972-470-5859
Practice Address - Fax:972-470-5861
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-21
Last Update Date:2019-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX132003246ZC0007X
TXSA00705246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXSA00705OtherLICENSED SURGICAL ASSISTANT