Healthcare Provider Details

I. General information

NPI: 1619441938
Provider Name (Legal Business Name): CHELSEA K CONNERS QMHS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHELSEA MOON

II. Dates (important events)

Enumeration Date: 01/21/2019
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

316 E MAIN ST
PIKETON OH
45661-8018
US

IV. Provider business mailing address

PO BOX 132
ATHENS OH
45701-0132
US

V. Phone/Fax

Practice location:
  • Phone: 800-321-8293
  • Fax: 844-623-7178
Mailing address:
  • Phone: 800-321-8293
  • Fax: 844-623-7178

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: