Provider Demographics
NPI:1962778993
Name:CHADWICK, ANGIE MICHELLE (FNP-C)
Entity type:Individual
Prefix:
First Name:ANGIE
Middle Name:MICHELLE
Last Name:CHADWICK
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 WALLACE BLVD
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79106-1708
Mailing Address - Country:US
Mailing Address - Phone:806-468-4300
Mailing Address - Fax:806-468-4398
Practice Address - Street 1:1901 MEDI PARK DR
Practice Address - Street 2:STE 2051
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79106-2169
Practice Address - Country:US
Practice Address - Phone:806-468-4300
Practice Address - Fax:806-468-4398
Is Sole Proprietor?:No
Enumeration Date:2012-03-23
Last Update Date:2013-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX764458363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX296691302Medicaid
OK200422580 AMedicaid
NM55951759Medicaid
TX296691301Medicaid
NM55951759Medicaid