Provider Demographics
NPI:1083385934
Name:PETRIE, CHELSIE RAE-ANNE (FNP-C)
Entity Type:Individual
Prefix:
First Name:CHELSIE
Middle Name:RAE-ANNE
Last Name:PETRIE
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 1:1928 S 4TH ST
Mailing Address - Street 2:
Mailing Address - City:CHICKASHA
Mailing Address - State:OK
Mailing Address - Zip Code:73018-5903
Mailing Address - Country:US
Mailing Address - Phone:405-224-6700
Mailing Address - Fax:405-400-0170
Practice Address - Street 1:1928 S 4TH ST
Practice Address - Street 2:
Practice Address - City:CHICKASHA
Practice Address - State:OK
Practice Address - Zip Code:73018-5903
Practice Address - Country:US
Practice Address - Phone:405-224-6700
Practice Address - Fax:405-400-0170
Is Sole Proprietor?:No
Enumeration Date:2021-09-21
Last Update Date:2023-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK205535363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily