Healthcare Provider Details

I. General information

NPI: 1003722273
Provider Name (Legal Business Name): MRS. GLORIA NICOLE ARMSTEAD- CHISM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2026
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4111 BARRON AVE
MEMPHIS TN
38111-7209
US

IV. Provider business mailing address

4111 BARRON AVE
MEMPHIS TN
38111-7209
US

V. Phone/Fax

Practice location:
  • Phone: 901-570-9753
  • Fax:
Mailing address:
  • Phone: 901-570-9753
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: