Basic Information
| Provider Information | |||||||||
| NPI: | 1710304068 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | POWELL | ||||||||
| FirstName: | CHELSEA | ||||||||
| MiddleName: | |||||||||
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| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | MONTGOMERY | ||||||||
| OtherFirstName: | CHELSEA | ||||||||
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| OtherCredential: | M.D. | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 2214 CANTERBURY DR STE 204 | ||||||||
| Address2: | |||||||||
| City: | HAYS | ||||||||
| State: | KS | ||||||||
| PostalCode: | 676012375 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7856232360 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2214 CANTERBURY DR STE 204 | ||||||||
| Address2: | |||||||||
| City: | HAYS | ||||||||
| State: | KS | ||||||||
| PostalCode: | 676012375 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7856232360 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/25/2014 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 04-39691 | KS | Y | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.