Provider Demographics
NPI:1235622929
Name:JACKSON, CHELSEA NICOLE (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:CHELSEA
Middle Name:NICOLE
Last Name:JACKSON
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 1:3333 BROOKVIEW HILLS BLVD
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-5661
Mailing Address - Country:US
Mailing Address - Phone:336-360-2407
Mailing Address - Fax:336-701-6740
Practice Address - Street 1:3333 BROOKVIEW HILLS BLVD
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-5661
Practice Address - Country:US
Practice Address - Phone:336-360-2407
Practice Address - Fax:336-701-6740
Is Sole Proprietor?:No
Enumeration Date:2018-06-07
Last Update Date:2022-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5010583363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
0OtherN/A