Healthcare Provider Details

I. General information

NPI: 1962944355
Provider Name (Legal Business Name): CHELSEA MASHBURN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2016
Last Update Date: 01/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 PROVIDENCE PARK DR E STE 102
MOBILE AL
36695-4618
US

IV. Provider business mailing address

8297 AMANDA LN
IRVINGTON AL
36544-4512
US

V. Phone/Fax

Practice location:
  • Phone: 251-639-5070
  • Fax: 251-634-2994
Mailing address:
  • Phone: 334-791-2596
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA.1187
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberPA-1187
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: