Provider Demographics
NPI:1568520864
Name:IRVIN, CHANDRA E (APN)
Entity Type:Individual
Prefix:
First Name:CHANDRA
Middle Name:E
Last Name:IRVIN
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1219
Mailing Address - Street 2:
Mailing Address - City:BURNET
Mailing Address - State:TX
Mailing Address - Zip Code:78611-7219
Mailing Address - Country:US
Mailing Address - Phone:830-596-3081
Mailing Address - Fax:512-756-6405
Practice Address - Street 1:3201 S WATER ST
Practice Address - Street 2:SETON HIGHLAND LAKES CARE-A-VAN
Practice Address - City:BURNET
Practice Address - State:TX
Practice Address - Zip Code:78611-4510
Practice Address - Country:US
Practice Address - Phone:830-596-3081
Practice Address - Fax:512-756-6405
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2020-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP108157363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX557553OtherLICENSE