Basic Information
| Provider Information | |||||||||
| NPI: | 1366962748 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HAVELKA | ||||||||
| FirstName: | CHELSEA | ||||||||
| MiddleName: | LAUREN | ||||||||
| NamePrefix: | |||||||||
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| Credential: | APRN | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | KERLIN | ||||||||
| OtherFirstName: | CHELSEA | ||||||||
| OtherMiddleName: | |||||||||
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| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 49 HIGHWAY 62 412 | ||||||||
| Address2: | |||||||||
| City: | ASH FLAT | ||||||||
| State: | AR | ||||||||
| PostalCode: | 725139594 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8709940730 | ||||||||
| FaxNumber: | 8709947488 | ||||||||
| Practice Location | |||||||||
| Address1: | 106 HIGHWAY 62 W | ||||||||
| Address2: | |||||||||
| City: | SALEM | ||||||||
| State: | AR | ||||||||
| PostalCode: | 725768059 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8708952015 | ||||||||
| FaxNumber: | 8708952164 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/26/2017 | ||||||||
| LastUpdateDate: | 06/26/2017 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | A005213 | AR | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.