Provider Demographics
NPI:1356976161
Name:HARRIS, CHELSEA KENNEDY (CRNA, DNP)
Entity type:Individual
Prefix:MRS
First Name:CHELSEA
Middle Name:KENNEDY
Last Name:HARRIS
Suffix:
Gender:F
Credentials:CRNA, DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3545 HARMONY HWY
Mailing Address - Street 2:
Mailing Address - City:HARMONY
Mailing Address - State:NC
Mailing Address - Zip Code:28634-9438
Mailing Address - Country:US
Mailing Address - Phone:704-929-1802
Mailing Address - Fax:
Practice Address - Street 1:1 MEDICAL CENTER BLVD
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27157-7505
Practice Address - Country:US
Practice Address - Phone:888-716-9253
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-12
Last Update Date:2022-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC277569163W00000X
390200000X
NC138479367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program