Provider Demographics
NPI:1851405534
Name:CHARETTE, VANESSA S (MD)
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:S
Last Name:CHARETTE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 733784
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75373-3784
Mailing Address - Country:US
Mailing Address - Phone:682-885-1855
Mailing Address - Fax:682-885-1396
Practice Address - Street 1:1263 W ROSEDALE ST
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-2830
Practice Address - Country:US
Practice Address - Phone:817-336-4896
Practice Address - Fax:817-332-2805
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2021-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL3940208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00U87ZOtherBCBSTX GRP PIN
TX139348100OtherFIRSTCARE PIN
TX0210683OtherCIGNA PIN
TX137345810Medicaid
TX88704GOtherBCBSTX IND PIN
TX10007799OtherAMERIGROUP PIN
TX113062OtherSUPERIOR PIN
1750369203OtherGRP NPI NUMBER
TX2217805OtherUHC PIN
TX140442852Medicaid
TX151940701Medicaid
TX151940703Medicaid
TX1998085OtherFIRSTHEALTH PIN
TX7115358OtherAETNA PIN
TX1998085OtherFIRSTHEALTH PIN
TX10007799OtherAMERIGROUP PIN
TX00U87ZOtherBCBSTX GRP PIN