Provider Demographics
NPI:1043992118
Name:ELMORE, CHELSEA (FNP-C)
Entity Type:Individual
Prefix:
First Name:CHELSEA
Middle Name:
Last Name:ELMORE
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:840 PINE ST STE 880
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31201-7525
Mailing Address - Country:US
Mailing Address - Phone:478-743-7092
Mailing Address - Fax:
Practice Address - Street 1:840 PINE ST STE 880
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31201-7525
Practice Address - Country:US
Practice Address - Phone:478-743-7092
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-07
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GANCO-000001363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily