Provider Demographics
NPI:1518302645
Name:CHAUDHRY, KASIM (FNP)
Entity Type:Individual
Prefix:
First Name:KASIM
Middle Name:
Last Name:CHAUDHRY
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2548 MEMORIAL BLVD
Mailing Address - Street 2:
Mailing Address - City:PORT ARTHUR
Mailing Address - State:TX
Mailing Address - Zip Code:77640-2825
Mailing Address - Country:US
Mailing Address - Phone:409-983-1161
Mailing Address - Fax:409-982-0978
Practice Address - Street 1:103 W GIBSON ST
Practice Address - Street 2:SUITE 110
Practice Address - City:JASPER
Practice Address - State:TX
Practice Address - Zip Code:75951-4977
Practice Address - Country:US
Practice Address - Phone:409-983-1161
Practice Address - Fax:409-982-0978
Is Sole Proprietor?:No
Enumeration Date:2013-05-02
Last Update Date:2013-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX758101363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily