Healthcare Provider Details

I. General information

NPI: 1003575838
Provider Name (Legal Business Name): CH MSSP SERVICES TN PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/09/2021
Last Update Date: 07/24/2025
Certification Date: 07/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 PEABODY PL STE 150
MEMPHIS TN
38103-3687
US

IV. Provider business mailing address

5750 JOHNSTON ST STE 205
LAFAYETTE LA
70503-5345
US

V. Phone/Fax

Practice location:
  • Phone: 337-991-9276
  • Fax:
Mailing address:
  • Phone: 337-408-0797
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: NICOLE HOWARD
Title or Position: SR VP OF ADMINISTRATIVE SERVICES
Credential:
Phone: 337-408-0797