Provider Demographics
NPI:1376174706
Name:OWEN, CHELSEA T (PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:CHELSEA
Middle Name:T
Last Name:OWEN
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:CHELSEA
Other - Middle Name:T
Other - Last Name:JOSE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PMHNP-BC
Mailing Address - Street 1:508 N MAIN ST STE A
Mailing Address - Street 2:
Mailing Address - City:HINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31313-2570
Mailing Address - Country:US
Mailing Address - Phone:912-785-2100
Mailing Address - Fax:844-848-5854
Practice Address - Street 1:508 N MAIN ST STE A
Practice Address - Street 2:
Practice Address - City:HINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:31313-2570
Practice Address - Country:US
Practice Address - Phone:912-785-2100
Practice Address - Fax:844-848-5854
Is Sole Proprietor?:No
Enumeration Date:2020-02-04
Last Update Date:2022-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN204790163W00000X, 363LP0808X
MECNP201052363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse