Healthcare Provider Details

I. General information

NPI: 1942987953
Provider Name (Legal Business Name): CHELSEY MACKENZIE CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHELSEY HICKERSON

II. Dates (important events)

Enumeration Date: 06/30/2023
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

621 S NEW BALLAS RD STE 1015B
SAINT LOUIS MO
63141-8203
US

IV. Provider business mailing address

PO BOX 776084
CHICAGO IL
60677-6084
US

V. Phone/Fax

Practice location:
  • Phone: 314-251-8965
  • Fax:
Mailing address:
  • Phone: 314-251-8965
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number2025019375
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: