Healthcare Provider Details

I. General information

NPI: 1033727383
Provider Name (Legal Business Name): KARISSA SIMONE BERTRAND B.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2020
Last Update Date: 07/22/2020
Certification Date: 07/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1921 RANSOM PL
NASHVILLE TN
37217-3841
US

IV. Provider business mailing address

3417 LEBANON PIKE APT J106
HERMITAGE TN
37076-2026
US

V. Phone/Fax

Practice location:
  • Phone: 615-279-6700
  • Fax:
Mailing address:
  • Phone: 315-854-2914
  • 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: