Provider Demographics
NPI:1639567118
Name:FAUST, CHELSEA WOOD (PAC)
Entity Type:Individual
Prefix:MS
First Name:CHELSEA
Middle Name:WOOD
Last Name:FAUST
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:266 S MEGOZZO DR
Mailing Address - Street 2:
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84770-1395
Mailing Address - Country:US
Mailing Address - Phone:208-715-1019
Mailing Address - Fax:208-939-5010
Practice Address - Street 1:617 E RIVERSIDE DR STE 103
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790-8720
Practice Address - Country:US
Practice Address - Phone:435-218-7779
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-06
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPA-1481363A00000X
NDPAC0938363A00000X
CAPA53588363AM0700X
UT9225187-1206363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NDPAC0938OtherSTATE LICENSE