Provider Demographics
NPI:1598399560
Name:CLARK, CHELSEA LAUREN (PA-C)
Entity Type:Individual
Prefix:
First Name:CHELSEA
Middle Name:LAUREN
Last Name:CLARK
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:CHELSEA
Other - Middle Name:LAUREN
Other - Last Name:KLINGSHIRN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:710 CLEVELAND AVE
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:OH
Mailing Address - Zip Code:43420-3224
Mailing Address - Country:US
Mailing Address - Phone:419-334-6657
Mailing Address - Fax:
Practice Address - Street 1:710 CLEVELAND AVE
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:OH
Practice Address - Zip Code:43420-3224
Practice Address - Country:US
Practice Address - Phone:419-334-6657
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-27
Last Update Date:2023-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.006374RX363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant