Provider Demographics
NPI:1043964927
Name:VANCE, CHELSEA JO (APRN)
Entity type:Individual
Prefix:
First Name:CHELSEA
Middle Name:JO
Last Name:VANCE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:CHELSEA
Other - Middle Name:JO
Other - Last Name:YATES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1335 US HIGHWAY 41A S
Mailing Address - Street 2:
Mailing Address - City:DIXON
Mailing Address - State:KY
Mailing Address - Zip Code:42409-9447
Mailing Address - Country:US
Mailing Address - Phone:270-635-2423
Mailing Address - Fax:
Practice Address - Street 1:1355 US HIGHWAY 41A S
Practice Address - Street 2:
Practice Address - City:DIXON
Practice Address - State:KY
Practice Address - Zip Code:42409-9447
Practice Address - Country:US
Practice Address - Phone:270-639-9101
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-09
Last Update Date:2022-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3017239363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily