Provider Demographics
NPI:1962944355
Name:MASHBURN, CHELSEA (PA-C)
Entity type:Individual
Prefix:MRS
First Name:CHELSEA
Middle Name:
Last Name:MASHBURN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8297 AMANDA LN
Mailing Address - Street 2:
Mailing Address - City:IRVINGTON
Mailing Address - State:AL
Mailing Address - Zip Code:36544-4512
Mailing Address - Country:US
Mailing Address - Phone:334-791-2596
Mailing Address - Fax:
Practice Address - Street 1:610 PROVIDENCE PARK DR E STE 102
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36695-4618
Practice Address - Country:US
Practice Address - Phone:251-639-5070
Practice Address - Fax:251-634-2994
Is Sole Proprietor?:No
Enumeration Date:2016-11-16
Last Update Date:2019-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPA.1187363A00000X
ALPA-1187207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant