Provider Demographics
NPI:1063011468
Name:BAUMGARDNER, CHELSEA ROSHELL (APRN)
Entity Type:Individual
Prefix:
First Name:CHELSEA
Middle Name:ROSHELL
Last Name:BAUMGARDNER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:596 WESTPORT RD STE 101
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:42701-2998
Mailing Address - Country:US
Mailing Address - Phone:270-796-6888
Mailing Address - Fax:270-769-9199
Practice Address - Street 1:596 WESTPORT RD STE 101
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:KY
Practice Address - Zip Code:42701-2998
Practice Address - Country:US
Practice Address - Phone:270-796-6888
Practice Address - Fax:270-769-9199
Is Sole Proprietor?:No
Enumeration Date:2020-10-19
Last Update Date:2022-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3015016363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100698940Medicaid