Provider Demographics
NPI:1326655853
Name:CALLISON, CHLOE (PA-C)
Entity Type:Individual
Prefix:
First Name:CHLOE
Middle Name:
Last Name:CALLISON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1222 KERCHER ST
Mailing Address - Street 2:
Mailing Address - City:MIAMISBURG
Mailing Address - State:OH
Mailing Address - Zip Code:45342-1904
Mailing Address - Country:US
Mailing Address - Phone:937-623-0307
Mailing Address - Fax:
Practice Address - Street 1:1222 KERCHER ST
Practice Address - Street 2:
Practice Address - City:MIAMISBURG
Practice Address - State:OH
Practice Address - Zip Code:45342-1904
Practice Address - Country:US
Practice Address - Phone:937-623-0307
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-29
Last Update Date:2020-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.006546RX363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant