Provider Demographics
NPI:1992100663
Name:NAGEL, CHARLES ALLEN (PA-C)
Entity type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:ALLEN
Last Name:NAGEL
Suffix:
Gender:M
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 1:534 FM 2550 RD
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:77320-1971
Mailing Address - Country:US
Mailing Address - Phone:936-662-6370
Mailing Address - Fax:
Practice Address - Street 1:534 FM 2550 RD
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:TX
Practice Address - Zip Code:77320-1971
Practice Address - Country:US
Practice Address - Phone:936-662-6370
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-23
Last Update Date:2014-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA03336363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical