1710532916 NPI number — MRS. CHELSEA LEEANN WALTON-CONNER PA-C

Table of content: AMANDA THOMPSON MSW LSCWA (NPI 1316626062)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710532916 NPI number — MRS. CHELSEA LEEANN WALTON-CONNER PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WALTON-CONNER
Provider First Name:
CHELSEA
Provider Middle Name:
LEEANN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
PA-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WESTWOOD
Provider Other First Name:
CHELSEA
Provider Other Middle Name:
LEEANN
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1710532916
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/06/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
550 CLUB LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CONWAY
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72034-3681
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
501-329-1510
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
550 CLUB LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CONWAY
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72034-3681
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
501-329-1510
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/05/2019

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363A00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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