Provider Demographics
NPI:1447694658
Name:WILSON, CHELSEA (RT)
Entity type:Individual
Prefix:
First Name:CHELSEA
Middle Name:
Last Name:WILSON
Suffix:
Gender:F
Credentials:RT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9998 CROSSPOINT BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46256-3307
Mailing Address - Country:US
Mailing Address - Phone:317-806-8285
Mailing Address - Fax:317-579-2130
Practice Address - Street 1:9998 CROSSPOINT BLVD STE 200
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46256-3307
Practice Address - Country:US
Practice Address - Phone:317-806-8285
Practice Address - Fax:317-579-2130
Is Sole Proprietor?:No
Enumeration Date:2013-04-18
Last Update Date:2021-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN10000679A363AM0700X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300022799Medicaid