=====================================================
General NPI Number Information
=====================================================
NPI Number | 1982561544
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CHELSEA ARLENA ERVIN RDA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/06/2026
-----------------------------------------------------
Last Update Date | 01/06/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4330 MAYNARDVILLE HWY
-----------------------------------------------------
City | MAYNARDVILLE
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37807-3579
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 865-992-3849
-----------------------------------------------------
Fax | 865-992-5166
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1923 SULPHUR SPRINGS RD
-----------------------------------------------------
City | MORRISTOWN
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37813-5654
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 423-317-9344
-----------------------------------------------------
Fax | 423-714-2355
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 126800000X
-----------------------------------------------------
Taxonomy Name | Dental Assistant
-----------------------------------------------------
License Number | 26425
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------