Healthcare Provider Details

I. General information

NPI: 1457996720
Provider Name (Legal Business Name): CARLA ANNE DAHM MSN, APN, PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/11/2019
Last Update Date: 01/26/2021
Certification Date: 01/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1805 INGLESIDE AVE
ATHENS TN
37303-2105
US

IV. Provider business mailing address

3925 ADKISSON DR NW APT 3612
CLEVELAND TN
37312-3097
US

V. Phone/Fax

Practice location:
  • Phone: 423-745-8802
  • Fax:
Mailing address:
  • Phone: 423-464-5405
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number26697
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: