Basic Information
| Provider Information | |||||||||
| NPI: | 1912329475 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CHALAS | ||||||||
| FirstName: | AMBER | ||||||||
| MiddleName: | AMY | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1009 WINDCROSS CT | ||||||||
| Address2: | STE 101 | ||||||||
| City: | FRANKLIN | ||||||||
| State: | TN | ||||||||
| PostalCode: | 370672678 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6152245438 | ||||||||
| FaxNumber: | 8552478787 | ||||||||
| Practice Location | |||||||||
| Address1: | 5749 SAN FELIPE ST | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770573101 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2082513418 | ||||||||
| FaxNumber: | 8552478787 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/16/2014 | ||||||||
| LastUpdateDate: | 11/07/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | PA08884 | TX | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
ID Information
| ID | Type | State | Issuer | Description | 360473YWZ9 | 01 | TX | MEDICARE ID | OTHER |