Provider Demographics
NPI:1104602382
Name:TYSON, CHELSEA NICOLE (NP-C)
Entity type:Individual
Prefix:MRS
First Name:CHELSEA
Middle Name:NICOLE
Last Name:TYSON
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7384 CAPULIN CREST DR
Mailing Address - Street 2:
Mailing Address - City:APEX
Mailing Address - State:NC
Mailing Address - Zip Code:27539-4106
Mailing Address - Country:US
Mailing Address - Phone:252-561-6900
Mailing Address - Fax:
Practice Address - Street 1:7511 MOURNING DOVE RD STE 101
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615-5097
Practice Address - Country:US
Practice Address - Phone:252-561-6900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-05
Last Update Date:2023-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCTYSO-T47G1363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner