Healthcare Provider Details

I. General information

NPI: 1215540851
Provider Name (Legal Business Name): STANLEY NNAMDI CHIMA PMHNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2020
Last Update Date: 03/14/2023
Certification Date: 03/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3881 STEWART LN
NASHVILLE TN
37243-4273
US

IV. Provider business mailing address

PO BOX 26
CUNNINGHAM TN
37052-0026
US

V. Phone/Fax

Practice location:
  • Phone: 501-952-7632
  • Fax:
Mailing address:
  • Phone: 501-952-7632
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License Number125284
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number28760
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: