Provider Demographics
NPI:1679029045
Name:MCCLURKIN, CHANIN (APRN)
Entity type:Individual
Prefix:
First Name:CHANIN
Middle Name:
Last Name:MCCLURKIN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10413 WALPOLE LN
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78739-1553
Mailing Address - Country:US
Mailing Address - Phone:310-713-4847
Mailing Address - Fax:
Practice Address - Street 1:10413 WALPOLE LN
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78739-1553
Practice Address - Country:US
Practice Address - Phone:310-713-4847
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-26
Last Update Date:2017-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP129806363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics