Healthcare Provider Details

I. General information

NPI: 1629341334
Provider Name (Legal Business Name): CHELSEY BLAKE PHILPOT APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/13/2012
Last Update Date: 12/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2135 HIGHWAY 30 BYP SUITE 2
LONDON KY
40741-6139
US

IV. Provider business mailing address

2135 HIGHWAY 30 BYP STE 2
LONDON KY
40741-6139
US

V. Phone/Fax

Practice location:
  • Phone: 606-878-1181
  • Fax: 606-878-1267
Mailing address:
  • Phone: 606-878-1181
  • Fax: 606-878-1267

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number3007337
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: