Provider Demographics
NPI:1750395398
Name:MARTIN, CHESNEY RICHARDSON (PA-C, MPAS)
Entity type:Individual
Prefix:MS
First Name:CHESNEY
Middle Name:RICHARDSON
Last Name:MARTIN
Suffix:
Gender:F
Credentials:PA-C, MPAS
Other - Prefix:
Other - First Name:CHESNEY
Other - Middle Name:RASHELLE
Other - Last Name:RICHARDSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7403 CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59405-8614
Mailing Address - Country:US
Mailing Address - Phone:304-777-3368
Mailing Address - Fax:
Practice Address - Street 1:1101 7TH AVE S
Practice Address - Street 2:
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59405-2267
Practice Address - Country:US
Practice Address - Phone:406-454-6973
Practice Address - Fax:406-791-9277
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2023-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810027154Medicaid