Healthcare Provider Details

I. General information

NPI: 1346765278
Provider Name (Legal Business Name): CHELSEA BROOK PARNELL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CHELSEA BROOK PARNELL

II. Dates (important events)

Enumeration Date: 08/11/2017
Last Update Date: 08/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1051 S RIVERSIDE DR
CLARKSVILLE TN
37040-4303
US

IV. Provider business mailing address

1051 S RIVERSIDE DR
CLARKSVILLE TN
37040-4303
US

V. Phone/Fax

Practice location:
  • Phone: 931-645-2494
  • Fax: 931-919-1218
Mailing address:
  • Phone: 931-645-2494
  • Fax: 931-919-1218

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number0000055269
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: