Provider Demographics
NPI:1487218764
Name:BLACK, CHELSEA GEBS (PA-C)
Entity Type:Individual
Prefix:
First Name:CHELSEA
Middle Name:GEBS
Last Name:BLACK
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:CHELSEA
Other - Middle Name:BIANCA
Other - Last Name:GEBS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2064 BELLA BREEZE CT
Mailing Address - Street 2:
Mailing Address - City:NAVARRE
Mailing Address - State:FL
Mailing Address - Zip Code:32566-3016
Mailing Address - Country:US
Mailing Address - Phone:804-350-2209
Mailing Address - Fax:
Practice Address - Street 1:405 OWEN DR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-3411
Practice Address - Country:US
Practice Address - Phone:910-323-3183
Practice Address - Fax:910-745-8478
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-23
Last Update Date:2021-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-11109363A00000X
FLPA9113351363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant