Healthcare Provider Details

I. General information

NPI: 1225878457
Provider Name (Legal Business Name): ROSHNEY THOMAS PUTHANKALAM PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2024
Last Update Date: 05/30/2024
Certification Date: 05/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7200 RHEA COUNTY HWY
DAYTON TN
37321-6288
US

IV. Provider business mailing address

8493 MAPLE VALLEY DR
CHATTANOOGA TN
37421-1398
US

V. Phone/Fax

Practice location:
  • Phone: 423-570-0077
  • Fax:
Mailing address:
  • Phone: 347-944-3870
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number35848
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: