Provider Demographics
NPI:1427416064
Name:OWEN, CHANIN (FNP)
Entity type:Individual
Prefix:
First Name:CHANIN
Middle Name:
Last Name:OWEN
Suffix:
Gender:F
Credentials:FNP
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 2078
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:TX
Mailing Address - Zip Code:76234-6156
Mailing Address - Country:US
Mailing Address - Phone:940-626-2300
Mailing Address - Fax:940-626-2315
Practice Address - Street 1:2010 BEN MERRITT DR
Practice Address - Street 2:SUITE A
Practice Address - City:DECATUR
Practice Address - State:TX
Practice Address - Zip Code:76234-3854
Practice Address - Country:US
Practice Address - Phone:940-626-2300
Practice Address - Fax:940-626-2315
Is Sole Proprietor?:No
Enumeration Date:2016-02-09
Last Update Date:2017-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP130078363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX356910501Medicaid
TX8239NWOtherBCBSTX
TX8239NWOtherBCBSTX