Provider Demographics
NPI:1912400425
Name:MULHOLLAND, CHELSIE LYNN (PA)
Entity Type:Individual
Prefix:
First Name:CHELSIE
Middle Name:LYNN
Last Name:MULHOLLAND
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:CHELSIE
Other - Middle Name:LYNN
Other - Last Name:EVANS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:10050 KENNERLY RD STE 1500
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63128-2106
Mailing Address - Country:US
Mailing Address - Phone:314-525-1545
Mailing Address - Fax:
Practice Address - Street 1:10050 KENNERLY RD STE 1500
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63128-2106
Practice Address - Country:US
Practice Address - Phone:314-525-1545
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-10
Last Update Date:2021-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA56548363A00000X
MO2021038911363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant