Provider Demographics
NPI:1760746440
Name:CHELSE, ANA BARBARA T (MD)
Entity Type:Individual
Prefix:
First Name:ANA BARBARA
Middle Name:T
Last Name:CHELSE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:3 MARYLAND FARMS STE 200
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-5780
Mailing Address - Country:US
Mailing Address - Phone:615-346-8732
Mailing Address - Fax:888-468-6603
Practice Address - Street 1:211 SAINT FRANCIS DR
Practice Address - Street 2:
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63703-5049
Practice Address - Country:US
Practice Address - Phone:573-331-3000
Practice Address - Fax:573-331-5079
Is Sole Proprietor?:No
Enumeration Date:2012-06-27
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2022013897103G00000X, 2084N0402X
IL125060998208000000X
OH35C.0005522084N0402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child Neurology
No103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0019115Medicaid