Provider Demographics
NPI:1619228798
Name:MCDONALD, CHANDRA ANNE (PA-C)
Entity Type:Individual
Prefix:
First Name:CHANDRA
Middle Name:ANNE
Last Name:MCDONALD
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 1:5929 BALCONES DR STE 200
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78731-4280
Mailing Address - Country:US
Mailing Address - Phone:512-550-1800
Mailing Address - Fax:
Practice Address - Street 1:23530 KINGSLAND BLVD STE 203
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77494-7466
Practice Address - Country:US
Practice Address - Phone:713-766-5437
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-28
Last Update Date:2022-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPA.0003574363A00000X
TXPA11049363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO11473061Medicaid
P01635885OtherRAILROAD WORKERS MEDICARE FOR MOUNTAIN PEAKS URGENT CARE
CO260810YYS0OtherMEDICARE B FOR MOUNTAIN PEAKS URGENT CARE