MEDICARE: MRS. CHELSEA NICOLE FORD PHYSICIAN ASSISTANT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	8302	AZ

General Provider Information

NPI Number	:	1114523610
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CHELSEA NICOLE FORD PHYSICIAN ASSISTANT

Provider Business Mailing Address
First Line	:	13400 E SHEA BLVD
Second Line	:
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85259-5499
Country	:	US
Telephone Number	:	480-301-8000
Fax Number	:

Provider Business Practice Location Address
First Line	:	5424 W FETLOCK TRL
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85083-9304
Country	:	US
Telephone Number	:	623-533-7226
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/09/2020
Last Update Date	:	01/29/2021

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