Healthcare Provider Details

I. General information

NPI: 1417896192
Provider Name (Legal Business Name): ANISHA ANN TRAYLOR PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2026
Last Update Date: 03/30/2026
Certification Date: 03/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 CODY DR
BELLS TN
38006-3752
US

IV. Provider business mailing address

19 CODY DR
BELLS TN
38006-3752
US

V. Phone/Fax

Practice location:
  • Phone: 731-445-0707
  • Fax:
Mailing address:
  • Phone: 731-445-0707
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number41586
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: