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General NPI Number Information
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NPI Number | 1679103139
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Entity Type | Individual
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Provider Name | CHELSEA MOORHEAD FNP
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Gender | Female
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Dates
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Enumeration Date | 01/23/2020
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Last Update Date | 09/03/2021
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Provider Practice Location Address
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Address Line | 1055 HIGHWAY 49 S STE B
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City | RICHLAND
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State | MS
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Zip | 39218-7517
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Country | US
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Telephone | 769-251-1187
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Fax |
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Provider Business Mailing Address
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Address Line | 406 PORT ARBOR
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City | BRANDON
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State | MS
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Zip | 39047-7090
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Country | US
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Telephone | 662-364-0581
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 904400
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License Number State | MS
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