Basic Information
| Provider Information | |||||||||
| NPI: | 1740467802 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | VOTH | ||||||||
| FirstName: | CHELSEA | ||||||||
| MiddleName: | RENEE | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | PAC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 310 E WALNUT ST | ||||||||
| Address2: | |||||||||
| City: | GARDEN CITY | ||||||||
| State: | KS | ||||||||
| PostalCode: | 678465572 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6202759752 | ||||||||
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| Practice Location | |||||||||
| Address1: | 310 E WALNUT ST | ||||||||
| Address2: | |||||||||
| City: | GARDEN CITY | ||||||||
| State: | KS | ||||||||
| PostalCode: | 678465572 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6202759752 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/30/2008 | ||||||||
| LastUpdateDate: | 04/23/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/23/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 1367 | NE | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 363A00000X | 15-01478 | KS | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
ID Information
| ID | Type | State | Issuer | Description | 1367 | 01 | NE | STATE OF NEBRASKA DHHS | OTHER | 15-01478 | 01 | KS | KANSAS STATE BOARD OF HEALTH AND HUMAN SERVICES | OTHER |