=====================================================
General NPI Number Information
=====================================================
NPI Number | 1972019149
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CHELSI RAYFORD PA-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/23/2017
-----------------------------------------------------
Last Update Date | 11/18/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 911 NW 18TH AVE
-----------------------------------------------------
City | PORTLAND
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97209-2324
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 971-801-1370
-----------------------------------------------------
Fax | 971-544-1201
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2200 NE NEFF RD STE 204
-----------------------------------------------------
City | BEND
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97701-4281
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 541-382-8346
-----------------------------------------------------
Fax | 541-382-5796
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363A00000X
-----------------------------------------------------
Taxonomy Name | Physician Assistant
-----------------------------------------------------
License Number | PA191997
-----------------------------------------------------
License Number State | OR
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363A00000X
-----------------------------------------------------
Taxonomy Name | Physician Assistant
-----------------------------------------------------
License Number | PA60962035
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------