Provider Demographics
NPI:1235622929
Name:JACKSON, CHELSEA NICOLE (FNP-C)
Entity type:Individual
Prefix:MRS
First Name:CHELSEA
Middle Name:NICOLE
Last Name:JACKSON
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 360
Mailing Address - Street 2:
Mailing Address - City:SYLVA
Mailing Address - State:NC
Mailing Address - Zip Code:28779-0360
Mailing Address - Country:US
Mailing Address - Phone:888-339-6065
Mailing Address - Fax:828-538-4441
Practice Address - Street 1:3922 W MARKET ST
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27407-1304
Practice Address - Country:US
Practice Address - Phone:336-252-3993
Practice Address - Fax:855-308-2340
Is Sole Proprietor?:No
Enumeration Date:2018-06-07
Last Update Date:2025-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5010583363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC19YAMOtherBCBS NC
NC3164062OtherCIGNA
NCNN3436BOtherMEDICARE
NCQ00928703OtherRAILROAD MEDICARE
NCLX493E-ACOtherDEVOTED HEALTH
NC1235622929Medicaid