Provider Demographics
NPI:1134109432
Name:CHIDESTER, CATHLEEN YVONNE (PA-C)
Entity type:Individual
Prefix:MS
First Name:CATHLEEN
Middle Name:YVONNE
Last Name:CHIDESTER
Suffix:
Gender:
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 1:4707 EIGEL ST STE 100
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77007-3417
Mailing Address - Country:US
Mailing Address - Phone:713-960-1311
Mailing Address - Fax:713-960-1325
Practice Address - Street 1:2112 W DAVIS ST
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77304-2049
Practice Address - Country:US
Practice Address - Phone:713-960-1311
Practice Address - Fax:713-960-1325
Is Sole Proprietor?:No
Enumeration Date:2006-01-20
Last Update Date:2025-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601002189363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
1841756236OtherGROUP NPI
MIP52755Medicare UPIN