Provider Demographics
NPI:1841759461
Name:RUNNELS, CHLOE LAYNE (CAA)
Entity Type:Individual
Prefix:
First Name:CHLOE
Middle Name:LAYNE
Last Name:RUNNELS
Suffix:
Gender:F
Credentials:CAA
Other - Prefix:MS
Other - First Name:CHLOE
Other - Middle Name:LAYNE
Other - Last Name:ROUSH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CAA
Mailing Address - Street 1:PO BOX 844658
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-4658
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2600 E PFLUGERVILLE PKWY STE 100
Practice Address - Street 2:
Practice Address - City:PFLUGERVILLE
Practice Address - State:TX
Practice Address - Zip Code:78660-5999
Practice Address - Country:US
Practice Address - Phone:512-654-6100
Practice Address - Fax:512-654-6101
Is Sole Proprietor?:No
Enumeration Date:2019-03-13
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX28513337367H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367H00000XPhysician Assistants & Advanced Practice Nursing ProvidersAnesthesiologist Assistant