Healthcare Provider Details

I. General information

NPI: 1255829818
Provider Name (Legal Business Name): CHELSEA DAWN SMITH DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MISS CHELSEA DAWN BURCHFIELD

II. Dates (important events)

Enumeration Date: 04/28/2018
Last Update Date: 09/15/2022
Certification Date: 09/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 TRILLIUM WAY STE 306
CORBIN KY
40701-8426
US

IV. Provider business mailing address

5200 COMMERCE CROSSING 3RD FL
LOUISVILLE KY
40229
US

V. Phone/Fax

Practice location:
  • Phone: 606-526-4070
  • Fax: 606-526-4072
Mailing address:
  • Phone: 502-861-5278
  • Fax: 423-439-2440

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number04933
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number04933
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: