Provider Demographics
NPI:1699172049
Name:CLARK, CHELSEY (PA-C, RDN, CDCES,CLC)
Entity type:Individual
Prefix:MS
First Name:CHELSEY
Middle Name:
Last Name:CLARK
Suffix:
Gender:
Credentials:PA-C, RDN, CDCES,CLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 W 7TH AVE
Mailing Address - Street 2:
Mailing Address - City:BIG TIMBER
Mailing Address - State:MT
Mailing Address - Zip Code:59011-7695
Mailing Address - Country:US
Mailing Address - Phone:406-932-4199
Mailing Address - Fax:406-932-5490
Practice Address - Street 1:701 STOCK ST
Practice Address - Street 2:
Practice Address - City:BIG TIMBER
Practice Address - State:MT
Practice Address - Zip Code:59011-8071
Practice Address - Country:US
Practice Address - Phone:406-932-4199
Practice Address - Fax:406-932-5490
Is Sole Proprietor?:No
Enumeration Date:2014-12-01
Last Update Date:2025-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
MT21049133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered