Provider Demographics
NPI:1679891717
Name:BROWN, CHARA DE'ANDRE (PA-C)
Entity Type:Individual
Prefix:MS
First Name:CHARA
Middle Name:DE'ANDRE
Last Name:BROWN
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 CHILDERS DR
Mailing Address - Street 2:109
Mailing Address - City:BASTROP
Mailing Address - State:TX
Mailing Address - Zip Code:78602-4154
Mailing Address - Country:US
Mailing Address - Phone:512-321-3430
Mailing Address - Fax:
Practice Address - Street 1:201 CHILDERS DR
Practice Address - Street 2:109
Practice Address - City:BASTROP
Practice Address - State:TX
Practice Address - Zip Code:78602-4154
Practice Address - Country:US
Practice Address - Phone:512-321-3430
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-13
Last Update Date:2015-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA05997363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant