Provider Demographics
NPI:1174384440
Name:CHISHOLM, BREIANNE M (PMHNP)
Entity type:Individual
Prefix:
First Name:BREIANNE
Middle Name:M
Last Name:CHISHOLM
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:180 CHISHOLM LAKE RD
Mailing Address - Street 2:
Mailing Address - City:RIPLEY
Mailing Address - State:TN
Mailing Address - Zip Code:38063-5802
Mailing Address - Country:US
Mailing Address - Phone:731-589-0420
Mailing Address - Fax:
Practice Address - Street 1:1744 US HIGHWA 64
Practice Address - Street 2:
Practice Address - City:SOMERVILLE
Practice Address - State:TN
Practice Address - Zip Code:38068
Practice Address - Country:US
Practice Address - Phone:731-609-8992
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-23
Last Update Date:2024-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN35496363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health