Healthcare Provider Details

I. General information

NPI: 1104645571
Provider Name (Legal Business Name): MICHELLE NILUFAR KHOSHKHOU PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2024
Last Update Date: 02/11/2025
Certification Date: 02/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6110 SHALLOWFORD RD STE B
CHATTANOOGA TN
37421-1894
US

IV. Provider business mailing address

6110 SHALLOWFORD RD STE B
CHATTANOOGA TN
37421-1894
US

V. Phone/Fax

Practice location:
  • Phone: 888-291-4357
  • Fax: 423-296-6384
Mailing address:
  • Phone: 888-291-4357
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAP61601529
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number36664
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: