Healthcare Provider Details

I. General information

NPI: 1700204997
Provider Name (Legal Business Name): CHELSEA SULLIVAN MATHEWS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2014
Last Update Date: 08/12/2020
Certification Date: 08/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4301 W MARKHAM ST # 783
LITTLE ROCK AR
72205-7101
US

IV. Provider business mailing address

PO BOX 251420
LITTLE ROCK AR
72225-1420
US

V. Phone/Fax

Practice location:
  • Phone: 501-686-8000
  • Fax:
Mailing address:
  • Phone: 501-686-8000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberMD60943546
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code207XX0004X
TaxonomyOrthopaedic Foot and Ankle Surgery Physician
License NumberMD60943546
License Number StateWA
# 3
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberE-13258
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: