Provider Demographics
NPI:1689940140
Name:VARGHESE, SISSY CHACKO (NP)
Entity Type:Individual
Prefix:
First Name:SISSY
Middle Name:CHACKO
Last Name:VARGHESE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:SISSY
Other - Middle Name:
Other - Last Name:CHACKO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7610 N STEMMONS FWY STE 600
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75247-4228
Mailing Address - Country:US
Mailing Address - Phone:214-689-5960
Mailing Address - Fax:469-713-8084
Practice Address - Street 1:3242 PRESTON RD STE 200
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-3328
Practice Address - Country:US
Practice Address - Phone:972-867-0019
Practice Address - Fax:972-867-7785
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-29
Last Update Date:2021-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY337023363LF0000X
TXAP127288363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily