Provider Demographics
NPI:1013451277
Name:THORN, CHELSEA DANIELLE (APRN)
Entity type:Individual
Prefix:MRS
First Name:CHELSEA
Middle Name:DANIELLE
Last Name:THORN
Suffix:
Gender:F
Credentials:APRN
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 21890
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-4115
Mailing Address - Country:US
Mailing Address - Phone:502-907-0356
Mailing Address - Fax:502-919-9780
Practice Address - Street 1:1107 CROWN POINTE DR STE 107
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:KY
Practice Address - Zip Code:42701-7280
Practice Address - Country:US
Practice Address - Phone:270-506-3300
Practice Address - Fax:270-506-2843
Is Sole Proprietor?:No
Enumeration Date:2016-12-07
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3010893363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY2049392OtherWELLCARE OF KENTUCKY PROVIDER ID NUMBER
KYP02355602OtherRAILROAD MEDICARE ID NUMBER
KYQZZ000000163182OtherAETNA BETTER OF KENTUCKY PROVIDER ID NUMBER
000001311177OtherANTHEM PROVIDER ID NUMBER
IN300030856Medicaid
6335524OtherUNITED HEALTHCARE PROVIDER ID NUMBER
KY7100438700Medicaid
10974811OtherPRIME HEALTH SERVICES PROVIDER ID NUMBER
269683OtherSIHO PROVIDER ID NUMBER
CS2000600129OtherCARESOURCE PROVIDER ID NUMBER