Provider Demographics
NPI:1750079349
Name:CARSON, CHAD BRYANT (AGACNP)
Entity type:Individual
Prefix:
First Name:CHAD
Middle Name:BRYANT
Last Name:CARSON
Suffix:
Gender:M
Credentials:AGACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29358 DUBERRY RDG
Mailing Address - Street 2:
Mailing Address - City:BOERNE
Mailing Address - State:TX
Mailing Address - Zip Code:78015-4505
Mailing Address - Country:US
Mailing Address - Phone:806-252-2993
Mailing Address - Fax:
Practice Address - Street 1:4411 MEDICAL DR STE 210
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3849
Practice Address - Country:US
Practice Address - Phone:210-615-7700
Practice Address - Fax:210-615-1958
Is Sole Proprietor?:No
Enumeration Date:2023-05-01
Last Update Date:2023-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1116203363L00000X, 363LG0600X, 363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology