Provider Demographics
NPI:1417733304
Name:CHESTNUT, ADESUWA JACKLYN (APRN)
Entity Type:Individual
Prefix:
First Name:ADESUWA
Middle Name:JACKLYN
Last Name:CHESTNUT
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:929 GESSNER RD STE 2225
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77024-2584
Mailing Address - Country:US
Mailing Address - Phone:713-365-2935
Mailing Address - Fax:
Practice Address - Street 1:929 GESSNER RD STE 2225
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77024-2584
Practice Address - Country:US
Practice Address - Phone:713-365-2935
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-06
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1100083363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health