Basic Information
Provider Information
NPI: 1336650662
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: AIKINS
FirstName: CHELSEY
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: APRN
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 37
Address2:  
City: PROVIDENCE
State: KY
PostalCode: 424500037
CountryCode: US
TelephoneNumber: 2706677017
FaxNumber: 2706677584
Practice Location
Address1: 215 E MAIN ST
Address2:  
City: PROVIDENCE
State: KY
PostalCode: 424501261
CountryCode: US
TelephoneNumber: 2706677017
FaxNumber: 2706679065
Other Information
ProviderEnumerationDate: 10/13/2017
LastUpdateDate: 03/02/2018
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LF0000X3010810KYY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily

No ID Information.


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