Active NPI
Chelsea Gough
- Physician Assistant
- Charlotte, NC
National Provider Identifier
1124477377
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 0010-06438
- Practice address
- 340 Jake Alexander Blvd. West
Suite 105
Charlotte, NC 28203-5812 - Phone
- (704) 403-6240
- NPI assigned
- Jun 8, 2016
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 0010-06438 | NC | Primary |
Addresses
Primary practice location
340 Jake Alexander Blvd. West
Suite 105
Charlotte, NC 28203-5812
Mailing address
PO Box 602478
Charlotte, NC 28260-2478
Phone (704) 403-6240
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1124477377 | Medicaid | NC | |
| 2745PA | Medicaid | SC |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0010-06438 | NC | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1465344000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1488153600000",
"number": "1124477377",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 602478",
"city": "CHARLOTTE",
"state": "NC",
"postal_code": "282602478",
"telephone_number": "704-403-6240"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "340 JAKE ALEXANDER BLVD. WEST",
"address_2": "SUITE 105",
"city": "CHARLOTTE",
"state": "NC",
"postal_code": "282035812",
"telephone_number": "704-403-6240"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GOUGH",
"first_name": "CHELSEA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2016-06-08",
"last_updated": "2017-02-27",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "NC",
"license": "0010-06438",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1124477377",
"state": "NC"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "2745PA",
"state": "SC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Charlotte, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 27, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.