Healthcare Provider Details

I. General information

NPI: 1114845682
Provider Name (Legal Business Name): KINZY NICOLE ROYSDEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2026
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2339 MCCALLIE AVE STE 309
CHATTANOOGA TN
37404-3233
US

IV. Provider business mailing address

2339 MCCALLIE AVE STE 309
CHATTANOOGA TN
37404-3233
US

V. Phone/Fax

Practice location:
  • Phone: 423-493-1271
  • Fax:
Mailing address:
  • Phone: 423-493-1271
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number42298
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: