Provider Demographics
NPI:1568867216
Name:CHUNG, COURTNEY (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:COURTNEY
Middle Name:
Last Name:CHUNG
Suffix:
Gender:F
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 1:201 N 7TH ST
Mailing Address - Street 2:
Mailing Address - City:GATESVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76528-1306
Mailing Address - Country:US
Mailing Address - Phone:210-863-8023
Mailing Address - Fax:
Practice Address - Street 1:RR 2 BOX 4400
Practice Address - Street 2:
Practice Address - City:GATESVILLE
Practice Address - State:TX
Practice Address - Zip Code:76597-0001
Practice Address - Country:US
Practice Address - Phone:254-865-6663
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-23
Last Update Date:2022-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX00000000000000000000363AM0700X
TXPA09364363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical