MEDICARE: HALEY NICOLE CHISUM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2255A2300X	Athletic Trainer		VA

General Provider Information

NPI Number	:	1477344570
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HALEY NICOLE CHISUM

Provider Business Mailing Address
First Line	:	44 ZENTRY PL
Second Line	:
City	:	LYNCHBURG
State	:	VA
Zip	:	24502-1245
Country	:	US
Telephone Number	:	320-402-4405
Fax Number	:

Provider Business Practice Location Address
First Line	:	44 ZENTRY PL
Second Line	:
City	:	LYNCHBURG
State	:	VA
Zip	:	24502-1245
Country	:	US
Telephone Number	:	320-402-4405
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/16/2025
Last Update Date	:	06/03/2026

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Directions to “ HALEY NICOLE CHISUM ” Practice Location

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