Provider Demographics
NPI:1821530189
Name:MELLETT, CHELSEA MARLENE (ARNP)
Entity Type:Individual
Prefix:
First Name:CHELSEA
Middle Name:MARLENE
Last Name:MELLETT
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:CHELSEA
Other - Middle Name:MARLENE
Other - Last Name:FREI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5900 LEEDS LN
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33331-3260
Mailing Address - Country:US
Mailing Address - Phone:904-652-9441
Mailing Address - Fax:
Practice Address - Street 1:515 W COURT ST
Practice Address - Street 2:
Practice Address - City:PASCO
Practice Address - State:WA
Practice Address - Zip Code:99301-3737
Practice Address - Country:US
Practice Address - Phone:509-547-2204
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-17
Last Update Date:2016-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60679794363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily