MEDICARE: CHELSEY ALISSA GARRIS NP

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	363LF0000X	Family Nurse Practitioner	213398	AR

General Provider Information

NPI Number	:	1588477582
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHELSEY ALISSA GARRIS NP

Provider Business Mailing Address
First Line	:	1010 E HOLLYWOOD AVE
Second Line	:
City	:	BLYTHEVILLE
State	:	AR
Zip	:	72315-2552
Country	:	US
Telephone Number	:	870-409-7119
Fax Number	:

Provider Business Practice Location Address
First Line	:	1010 E HOLLYWOOD AVE
Second Line	:
City	:	BLYTHEVILLE
State	:	AR
Zip	:	72315-2552
Country	:	US
Telephone Number	:	870-409-7119
Fax Number	:

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

Provider Enumeration Date	:	01/31/2025
Last Update Date	:	01/31/2025

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