Provider Demographics
NPI:1255829818
Name:SMITH, CHELSEA DAWN (DO)
Entity Type:Individual
Prefix:DR
First Name:CHELSEA
Middle Name:DAWN
Last Name:SMITH
Suffix:
Gender:F
Credentials:DO
Other - Prefix:MISS
Other - First Name:CHELSEA
Other - Middle Name:DAWN
Other - Last Name:BURCHFIELD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5200 COMMERCE CROSSING
Mailing Address - Street 2:3RD FL
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40229
Mailing Address - Country:US
Mailing Address - Phone:502-861-5278
Mailing Address - Fax:423-439-2440
Practice Address - Street 1:2 TRILLIUM WAY STE 306
Practice Address - Street 2:
Practice Address - City:CORBIN
Practice Address - State:KY
Practice Address - Zip Code:40701-8426
Practice Address - Country:US
Practice Address - Phone:606-526-4070
Practice Address - Fax:606-526-4072
Is Sole Proprietor?:No
Enumeration Date:2018-04-28
Last Update Date:2022-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY04933207P00000X, 207Q00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program