Provider Demographics
NPI:1427127638
Name:CHADWICK, THERESA (PA-C)
Entity type:Individual
Prefix:
First Name:THERESA
Middle Name:
Last Name:CHADWICK
Suffix:
Gender:F
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 1:409 COTTAGE RD
Mailing Address - Street 2:
Mailing Address - City:CARTHAGE
Mailing Address - State:TX
Mailing Address - Zip Code:75633-1466
Mailing Address - Country:US
Mailing Address - Phone:903-693-3841
Mailing Address - Fax:903-694-4661
Practice Address - Street 1:409 COTTAGE RD
Practice Address - Street 2:
Practice Address - City:CARTHAGE
Practice Address - State:TX
Practice Address - Zip Code:75633-1466
Practice Address - Country:US
Practice Address - Phone:903-693-3841
Practice Address - Fax:903-694-4633
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2011-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA01697363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX063445302Medicaid
TX00374KOtherBLUE CROSS OF TEXAS
TX0063445303Medicaid
TX063445302Medicaid