Provider Demographics
NPI:1285097949
Name:THOMPSON, CHELSEA LEE (DO)
Entity type:Individual
Prefix:
First Name:CHELSEA
Middle Name:LEE
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 W KINGSHIGHWAY
Mailing Address - Street 2:SUITE 14
Mailing Address - City:PARAGOULD
Mailing Address - State:AR
Mailing Address - Zip Code:72450
Mailing Address - Country:US
Mailing Address - Phone:870-239-8591
Mailing Address - Fax:870-239-8137
Practice Address - Street 1:1110 W. KINGSHIGHWAY
Practice Address - Street 2:
Practice Address - City:PARAGOULD
Practice Address - State:AR
Practice Address - Zip Code:72450
Practice Address - Country:US
Practice Address - Phone:870-205-2000
Practice Address - Fax:870-205-2001
Is Sole Proprietor?:No
Enumeration Date:2016-03-31
Last Update Date:2024-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-11542207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR236591003Medicaid