Healthcare Provider Details

I. General information

NPI: 1649613324
Provider Name (Legal Business Name): RISSA PRYSE IVENS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2013
Last Update Date: 06/05/2020
Certification Date: 06/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

275 CUMBERLAND BND
NASHVILLE TN
37228-1805
US

IV. Provider business mailing address

275 CUMBERLAND BND
NASHVILLE TN
37228-1805
US

V. Phone/Fax

Practice location:
  • Phone: 866-816-0433
  • Fax: 615-743-1679
Mailing address:
  • Phone: 615-726-3340
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number55706
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: