Susan Chacko, APRN

Primary specialty

Primary Care Nurse PractitionerTaxonomy code 363LP2300X

License

AP140734 Issued in TX

Practice address

5200 Harry Hines Blvd
Dallas, TX 75235-7709

Phone

(516) 941-7930

NPI assigned

Dec 20, 2020

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1608422400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1608422400000",
    "number": "1710573159",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1024 BLUE HERON DR",
            "city": "FORNEY",
            "state": "TX",
            "postal_code": "751268311",
            "telephone_number": "516-941-7930"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5200 HARRY HINES BLVD",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752357709",
            "telephone_number": "516-941-7930"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHACKO",
        "first_name": "SUSAN",
        "credential": "APRN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-12-20",
        "last_updated": "2020-12-20",
        "certification_date": "2020-12-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "TX",
            "license": "AP140734",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Chelsea Chacko
• Manoj Chacko, BS
• Mathew Vadakkeveettil Chacko, PMHNP-BC
• Sarah Chacko, RN
• Sibi Chacko
• Marina Bliss Chacon
• Sophia Louise Chacon
• Chad Simmons, M.D., P.a.
• Chad T Fletcher DDS PA
• Poornima Chadalawada, MD

• Primary Care Nurse Practitioner in Dallas, TX
• Providers in Dallas, TX by specialty
• Primary Care Nurse Practitioner in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 20, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.