Provider Demographics
NPI:1750017109
Name:BUCHANAN, CHELSEA ELYSE (CPNP-PC)
Entity type:Individual
Prefix:
First Name:CHELSEA
Middle Name:ELYSE
Last Name:BUCHANAN
Suffix:
Gender:F
Credentials:CPNP-PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4114 POND HILL RD STE 101
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78231-1273
Mailing Address - Country:US
Mailing Address - Phone:210-249-5020
Mailing Address - Fax:210-494-2209
Practice Address - Street 1:4114 POND HILL RD STE 101
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78231-1273
Practice Address - Country:US
Practice Address - Phone:210-249-5020
Practice Address - Fax:210-494-2209
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-28
Last Update Date:2022-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1088565363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1088565OtherTEXAS BON