Provider Demographics
NPI:1104590181
Name:VICKERY, CHELSEA MOORE (FNP-C)
Entity type:Individual
Prefix:MRS
First Name:CHELSEA
Middle Name:MOORE
Last Name:VICKERY
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 1:116 CYPRESS CT
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:GA
Mailing Address - Zip Code:31811-5370
Mailing Address - Country:US
Mailing Address - Phone:706-570-2696
Mailing Address - Fax:
Practice Address - Street 1:2101 NORTH AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31904-8806
Practice Address - Country:US
Practice Address - Phone:706-221-8799
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-04
Last Update Date:2021-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN244722363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily