Provider Demographics
NPI:1457678955
Name:CHANDLER, CAROLYN G (PA)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:G
Last Name:CHANDLER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1402 E HOUSTON ST
Mailing Address - Street 2:
Mailing Address - City:BEEVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78102-5311
Mailing Address - Country:US
Mailing Address - Phone:361-358-7870
Mailing Address - Fax:361-358-0360
Practice Address - Street 1:1402 E HOUSTON ST
Practice Address - Street 2:
Practice Address - City:BEEVILLE
Practice Address - State:TX
Practice Address - Zip Code:78102-5311
Practice Address - Country:US
Practice Address - Phone:361-358-7870
Practice Address - Fax:361-358-0360
Is Sole Proprietor?:No
Enumeration Date:2010-04-23
Last Update Date:2010-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA00668363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical