Provider Demographics
NPI:1235869702
Name:CROSS, CHELSEA KENDALL (APRN FNP-BC)
Entity Type:Individual
Prefix:
First Name:CHELSEA
Middle Name:KENDALL
Last Name:CROSS
Suffix:
Gender:F
Credentials:APRN FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 BALANCE ROCK RD APT 22
Mailing Address - Street 2:
Mailing Address - City:SEYMOUR
Mailing Address - State:CT
Mailing Address - Zip Code:06483-6049
Mailing Address - Country:US
Mailing Address - Phone:203-731-1404
Mailing Address - Fax:
Practice Address - Street 1:3715 MAIN ST
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06606-3618
Practice Address - Country:US
Practice Address - Phone:203-371-7111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-16
Last Update Date:2022-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT10875363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily