Provider Demographics
NPI:1285789669
Name:COULTER, CHAD EMERY (CRNA)
Entity type:Individual
Prefix:
First Name:CHAD
Middle Name:EMERY
Last Name:COULTER
Suffix:
Gender:M
Credentials:CRNA
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 4157
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79704-4157
Mailing Address - Country:US
Mailing Address - Phone:432-520-0291
Mailing Address - Fax:432-520-2723
Practice Address - Street 1:2401 CROCKETT DR
Practice Address - Street 2:
Practice Address - City:BROWNWOOD
Practice Address - State:TX
Practice Address - Zip Code:76801-5941
Practice Address - Country:US
Practice Address - Phone:325-277-1748
Practice Address - Fax:850-785-6233
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2017-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP116335367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
U6587ZMedicare ID - Type UnspecifiedMEDICARE NUMBER
TX8J9277Medicare PIN
FLG3864OtherFL BCBS
P00279011OtherMEDICARE RAILROAD
FLARNP9233565OtherFL STATE LIC