Healthcare Provider Details

I. General information

NPI: 1053297846
Provider Name (Legal Business Name): CHELSEA PICKARD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2025
Last Update Date: 08/15/2025
Certification Date: 08/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 AVONDALE CIR
WEST MEMPHIS AR
72301-1794
US

IV. Provider business mailing address

1600 AVONDALE CIR
WEST MEMPHIS AR
72301-1794
US

V. Phone/Fax

Practice location:
  • Phone: 870-733-9950
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR097357
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: