Provider Demographics
NPI:1609278647
Name:JAVIER, CHELSIE (PA)
Entity Type:Individual
Prefix:
First Name:CHELSIE
Middle Name:
Last Name:JAVIER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:CHELSIE
Other - Middle Name:
Other - Last Name:CONKLIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:PO BOX 604042
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-4042
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2085 FRONTIS PLAZA BLVD
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-5614
Practice Address - Country:US
Practice Address - Phone:336-718-0050
Practice Address - Fax:704-316-0649
Is Sole Proprietor?:No
Enumeration Date:2014-09-22
Last Update Date:2022-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-05214363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant