Provider Demographics
NPI:1215476940
Name:CHUNG, VITA T (DNP, APRN, PMHNP-BC)
Entity type:Individual
Prefix:DR
First Name:VITA
Middle Name:T
Last Name:CHUNG
Suffix:
Gender:F
Credentials:DNP, APRN, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7435 HIGHWAY 6 S., SUITE C
Mailing Address - Street 2:
Mailing Address - City:MISSOURI CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77459-4293
Mailing Address - Country:US
Mailing Address - Phone:281-606-0622
Mailing Address - Fax:281-476-6454
Practice Address - Street 1:7435 HIGHWAY 6 S., SUITE C
Practice Address - Street 2:
Practice Address - City:MISSOURI CITY
Practice Address - State:TX
Practice Address - Zip Code:77459-4293
Practice Address - Country:US
Practice Address - Phone:281-606-0622
Practice Address - Fax:281-476-6454
Is Sole Proprietor?:No
Enumeration Date:2017-02-14
Last Update Date:2021-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP132878363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health