Provider Demographics
NPI:1326623521
Name:MOORE, CHELSEA LYN (PA)
Entity Type:Individual
Prefix:
First Name:CHELSEA
Middle Name:LYN
Last Name:MOORE
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:CHELSEA
Other - Middle Name:LYN
Other - Last Name:BRINKMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:PO BOX 100
Mailing Address - Street 2:
Mailing Address - City:PENDER
Mailing Address - State:NE
Mailing Address - Zip Code:68047-0100
Mailing Address - Country:US
Mailing Address - Phone:402-922-1701
Mailing Address - Fax:
Practice Address - Street 1:100 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:PENDER
Practice Address - State:NE
Practice Address - Zip Code:68047-4507
Practice Address - Country:US
Practice Address - Phone:402-385-3083
Practice Address - Fax:402-385-4041
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-10
Last Update Date:2022-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2587363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical