Provider Demographics
NPI:1871616342
Name:ACHO, CHIAMAKA F
Entity type:Individual
Prefix:MS
First Name:CHIAMAKA
Middle Name:F
Last Name:ACHO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4108 RANCHERO DR
Mailing Address - Street 2:
Mailing Address - City:SACHSE
Mailing Address - State:TX
Mailing Address - Zip Code:75048-4857
Mailing Address - Country:US
Mailing Address - Phone:214-417-5000
Mailing Address - Fax:
Practice Address - Street 1:7859 WALNUT HILL LN STE 200
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75230-5637
Practice Address - Country:US
Practice Address - Phone:214-369-7661
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-09
Last Update Date:2024-08-05
Deactivation Date:2008-03-25
Deactivation Code:
Reactivation Date:2013-04-30
Provider Licenses
StateLicense IDTaxonomies
TX1170318363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX677842Medicare Oscar/Certification