Provider Demographics
NPI:1003046780
Name:HEWITT, CHELSEA W (PA)
Entity Type:Individual
Prefix:MS
First Name:CHELSEA
Middle Name:W
Last Name:HEWITT
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:CHELSEA
Other - Middle Name:E
Other - Last Name:WALTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:76 16TH STREET
Mailing Address - Street 2:
Mailing Address - City:WHEELING
Mailing Address - State:WV
Mailing Address - Zip Code:26003
Mailing Address - Country:US
Mailing Address - Phone:304-238-0212
Mailing Address - Fax:304-238-0215
Practice Address - Street 1:76 16TH STREET
Practice Address - Street 2:
Practice Address - City:WHEELING
Practice Address - State:WV
Practice Address - Zip Code:26003
Practice Address - Country:US
Practice Address - Phone:304-238-0212
Practice Address - Fax:304-238-0215
Is Sole Proprietor?:No
Enumeration Date:2009-07-16
Last Update Date:2022-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1612363A00000X
WV473363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0372879Medicaid