Provider Demographics
NPI:1962640938
Name:COMBS, CHELSEA ANN (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:CHELSEA
Middle Name:ANN
Last Name:COMBS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MRS
Other - First Name:CHELSEA
Other - Middle Name:ANN
Other - Last Name:SANDERSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA-C
Mailing Address - Street 1:1301 BARBARA JORDAN BLVD STE 307
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78723-3077
Mailing Address - Country:US
Mailing Address - Phone:512-324-0000
Mailing Address - Fax:512-324-0645
Practice Address - Street 1:1301 BARBARA JORDAN BLVD STE 307
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78723-3077
Practice Address - Country:US
Practice Address - Phone:512-324-0000
Practice Address - Fax:512-324-0645
Is Sole Proprietor?:No
Enumeration Date:2009-01-29
Last Update Date:2013-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX205848901Medicaid
8L18082Medicare PIN