=====================================================
General NPI Number Information
=====================================================
NPI Number | 1770388852
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CHELSEA TARRANT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/13/2025
-----------------------------------------------------
Last Update Date | 02/13/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1424 LIVE OAK BLVD
-----------------------------------------------------
City | YUBA CITY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95991-2910
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 530-671-2344
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7036 MEADOWLARK LN
-----------------------------------------------------
City | SHERIDAN
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95681-9703
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 530-363-3047
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 124Q00000X
-----------------------------------------------------
Taxonomy Name | Dental Hygienist
-----------------------------------------------------
License Number | 24931
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------