1134109432 NPI number — MS. CATHLEEN YVONNE CHIDESTER PA-C

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134109432 NPI number — MS. CATHLEEN YVONNE CHIDESTER PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CHIDESTER
Provider First Name:
CATHLEEN
Provider Middle Name:
YVONNE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
PA-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1134109432
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/14/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4707 EIGEL ST STE 100
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOUSTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77007-3417
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
713-960-1311
Provider Business Mailing Address Fax Number:
713-960-1325

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2112 W DAVIS ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CONROE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77304-2049
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
713-960-1311
Provider Business Practice Location Address Fax Number:
713-960-1325
Provider Enumeration Date:
01/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363A00000X , with the licence number:  5601002189 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1841756236 . This is a "GROUP NPI" identifier . This identifiers is of the category "OTHER".




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