Provider Demographics
NPI:1164470266
Name:CHISUM, PATRICIA E (FNP)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:E
Last Name:CHISUM
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2300 RAMSEY ST
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28301-3856
Mailing Address - Country:US
Mailing Address - Phone:704-807-0620
Mailing Address - Fax:
Practice Address - Street 1:8039 ARABIA RD
Practice Address - Street 2:
Practice Address - City:LUMBER BRIDGE
Practice Address - State:NC
Practice Address - Zip Code:28357-8995
Practice Address - Country:US
Practice Address - Phone:704-807-0620
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2019-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0050-03247363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAQ30596Medicare UPIN