Provider Demographics
NPI:1063291144
Name:LEOS, CHELSEA (FNP)
Entity type:Individual
Prefix:
First Name:CHELSEA
Middle Name:
Last Name:LEOS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5909 WOLF WALK WAY APT 208
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27606-4099
Mailing Address - Country:US
Mailing Address - Phone:845-505-7502
Mailing Address - Fax:
Practice Address - Street 1:126 GRAND HILL PL
Practice Address - Street 2:
Practice Address - City:HOLLY SPRINGS
Practice Address - State:NC
Practice Address - Zip Code:27540-4416
Practice Address - Country:US
Practice Address - Phone:919-285-2138
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-27
Last Update Date:2023-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLEOS-U8RLG363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care