Provider Demographics
NPI:1346449535
Name:CHACKO, ANITA (RNP-C)
Entity Type:Individual
Prefix:
First Name:ANITA
Middle Name:
Last Name:CHACKO
Suffix:
Gender:F
Credentials:RNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9696 SKILLMAN ST
Mailing Address - Street 2:SUITE 285 LB 42
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75243-8264
Mailing Address - Country:US
Mailing Address - Phone:214-348-7611
Mailing Address - Fax:214-348-0129
Practice Address - Street 1:7441 MARVIN D LOVE FWY
Practice Address - Street 2:SUITE 300
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75237-3490
Practice Address - Country:US
Practice Address - Phone:972-572-1998
Practice Address - Fax:972-572-4842
Is Sole Proprietor?:No
Enumeration Date:2007-07-17
Last Update Date:2007-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX699985363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXQ62096Medicare UPIN
TX8G3387Medicare PIN