Provider Demographics
NPI:1467055632
Name:CHANEY, MARK DWAYNE (PA-C)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:DWAYNE
Last Name:CHANEY
Suffix:
Gender:M
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 1:2125 PINE ST
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79601-2435
Mailing Address - Country:US
Mailing Address - Phone:254-631-2233
Mailing Address - Fax:
Practice Address - Street 1:2125 PINE ST
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79601-2435
Practice Address - Country:US
Practice Address - Phone:325-677-5201
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-19
Last Update Date:2021-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant