=====================================================
General NPI Number Information
=====================================================
NPI Number | 1053297846
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CHELSEA PICKARD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/15/2025
-----------------------------------------------------
Last Update Date | 08/15/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1600 AVONDALE CIR
-----------------------------------------------------
City | WEST MEMPHIS
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72301-1794
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 870-733-9950
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1600 AVONDALE CIR
-----------------------------------------------------
City | WEST MEMPHIS
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72301-1794
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 163W00000X
-----------------------------------------------------
Taxonomy Name | Registered Nurse
-----------------------------------------------------
License Number | R097357
-----------------------------------------------------
License Number State | AR
-----------------------------------------------------