Basic Information
| Provider Information | |||||||||
| NPI: | 1962944355 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MASHBURN | ||||||||
| FirstName: | CHELSEA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8297 AMANDA LN | ||||||||
| Address2: | |||||||||
| City: | IRVINGTON | ||||||||
| State: | AL | ||||||||
| PostalCode: | 365444512 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3347912596 | ||||||||
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| Practice Location | |||||||||
| Address1: | 610 PROVIDENCE PARK DR E STE 102 | ||||||||
| Address2: | |||||||||
| City: | MOBILE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 366954618 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2516395070 | ||||||||
| FaxNumber: | 2516342994 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/16/2016 | ||||||||
| LastUpdateDate: | 01/02/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | PA.1187 | AL | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 207Q00000X | PA-1187 | AL | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.