Provider Demographics
NPI:1184108649
Name:JOHNSON, CHELSEA (DNP)
Entity type:Individual
Prefix:
First Name:CHELSEA
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4076 NEELY ROAD
Mailing Address - Street 2:
Mailing Address - City:FT. WAINWRIGHT
Mailing Address - State:AK
Mailing Address - Zip Code:99703-4712
Mailing Address - Country:US
Mailing Address - Phone:907-205-0205
Mailing Address - Fax:
Practice Address - Street 1:4076 NEELY ROAD
Practice Address - Street 2:
Practice Address - City:FT. WAINWRIGHT
Practice Address - State:AK
Practice Address - Zip Code:99703-4712
Practice Address - Country:US
Practice Address - Phone:907-205-0205
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-20
Last Update Date:2021-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK30449163WM0705X
390200000X
AK179509207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program