Provider Demographics
NPI:1629307806
Name:CHARTERS, JULIE ANNE (PA-C)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:ANNE
Last Name:CHARTERS
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 1:2800 ALDINE BENDER RD STE B
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77032-3502
Mailing Address - Country:US
Mailing Address - Phone:281-977-3800
Mailing Address - Fax:
Practice Address - Street 1:2800 ALDINE BENDER RD STE B
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77032-3502
Practice Address - Country:US
Practice Address - Phone:281-977-3800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-12-16
Last Update Date:2013-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA05809363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
1629307806OtherBLUE CROSS BLUE SHIELD TX
1629307806OtherTRICARE SOUTH
825N61OtherBLUE CROSS BLUE SHIELD TX INTERNAL#
825N61OtherBLUE CROSS BLUE SHIELD TX INTERNAL#
TXP01120787Medicare PIN
TXTXB110999Medicare PIN