Provider Demographics
NPI:1043953748
Name:CHANCE, KISHA LASHUN (PMHNP)
Entity Type:Individual
Prefix:MRS
First Name:KISHA
Middle Name:LASHUN
Last Name:CHANCE
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1043 STARLIGHT PL
Mailing Address - Street 2:
Mailing Address - City:ROCKWALL
Mailing Address - State:TX
Mailing Address - Zip Code:75087-2297
Mailing Address - Country:US
Mailing Address - Phone:214-668-6505
Mailing Address - Fax:
Practice Address - Street 1:1043 STARLIGHT PL
Practice Address - Street 2:
Practice Address - City:ROCKWALL
Practice Address - State:TX
Practice Address - Zip Code:75087-2297
Practice Address - Country:US
Practice Address - Phone:214-668-6505
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-19
Last Update Date:2022-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1067739363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health