Provider Demographics
NPI:1689057150
Name:KNOX, CHELSEA NICHOLE
Entity Type:Individual
Prefix:DR
First Name:CHELSEA
Middle Name:NICHOLE
Last Name:KNOX
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 554
Mailing Address - Street 2:
Mailing Address - City:SEARCY
Mailing Address - State:AR
Mailing Address - Zip Code:72145-0554
Mailing Address - Country:US
Mailing Address - Phone:479-484-7645
Mailing Address - Fax:
Practice Address - Street 1:8309 PHOENIX AVE
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72903-6141
Practice Address - Country:US
Practice Address - Phone:479-484-7645
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-02
Last Update Date:2015-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR40481223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice