Provider Demographics
NPI:1972218964
Name:HAMILTON, CHELLIE (APRN, FNP-C)
Entity Type:Individual
Prefix:
First Name:CHELLIE
Middle Name:
Last Name:HAMILTON
Suffix:
Gender:F
Credentials:APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2074 RICE ST
Mailing Address - Street 2:
Mailing Address - City:WALDRON
Mailing Address - State:AR
Mailing Address - Zip Code:72958-7435
Mailing Address - Country:US
Mailing Address - Phone:479-668-4700
Mailing Address - Fax:
Practice Address - Street 1:2074 RICE ST
Practice Address - Street 2:
Practice Address - City:WALDRON
Practice Address - State:AR
Practice Address - Zip Code:72958-7435
Practice Address - Country:US
Practice Address - Phone:479-668-4700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-16
Last Update Date:2023-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR123034363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty