Provider Demographics
NPI:1538424833
Name:ROSS, CHELSEY (APN)
Entity type:Individual
Prefix:
First Name:CHELSEY
Middle Name:
Last Name:ROSS
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1048 BOULDER DR
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72210-4789
Mailing Address - Country:US
Mailing Address - Phone:870-814-3659
Mailing Address - Fax:
Practice Address - Street 1:1048 BOULDER DR
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72210-4789
Practice Address - Country:US
Practice Address - Phone:870-814-3659
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-12
Last Update Date:2019-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA003723363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR363L00000XMedicaid
AR363L00000XMedicare Oscar/Certification
AR363L00000XMedicare UPIN
AR363L00000XMedicare PIN