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General NPI Number Information
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NPI Number | 1003575838
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Entity Type | Organization
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Legal Business Name | CH MSSP SERVICES TN PLLC
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Dates
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Enumeration Date | 12/09/2021
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Last Update Date | 07/24/2025
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Provider Practice Location Address
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Address Line | 100 PEABODY PL STE 150
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City | MEMPHIS
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State | TN
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Zip | 38103-3687
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Country | US
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Telephone | 337-991-9276
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Fax |
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Provider Business Mailing Address
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Address Line | 5750 JOHNSTON ST STE 205
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City | LAFAYETTE
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State | LA
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Zip | 70503-5345
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Country | US
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Telephone | 337-408-0797
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Fax |
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Authorized Official
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Title or Position | SR VP OF ADMINISTRATIVE SERVICES
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Name | NICOLE HOWARD
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Credential |
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Telephone | 337-408-0797
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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