Provider Demographics
NPI:1467448381
Name:BURCHETTE, CHELSEA C (PA-C)
Entity type:Individual
Prefix:MS
First Name:CHELSEA
Middle Name:C
Last Name:BURCHETTE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:741 NE 6TH ST
Mailing Address - Street 2:
Mailing Address - City:GRANTS PASS
Mailing Address - State:OR
Mailing Address - Zip Code:97526-1556
Mailing Address - Country:US
Mailing Address - Phone:541-471-2701
Mailing Address - Fax:541-471-1166
Practice Address - Street 1:741 NE 6TH ST
Practice Address - Street 2:
Practice Address - City:GRANTS PASS
Practice Address - State:OR
Practice Address - Zip Code:97526-1556
Practice Address - Country:US
Practice Address - Phone:541-471-2701
Practice Address - Fax:541-471-1166
Is Sole Proprietor?:No
Enumeration Date:2005-09-26
Last Update Date:2019-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORPA00781363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR135288Medicaid
OR135288Medicaid
OR111397Medicare ID - Type Unspecified