Provider Demographics
NPI:1437611449
Name:CHISHOLM, DELICIA ANN (ATP)
Entity Type:Individual
Prefix:
First Name:DELICIA
Middle Name:ANN
Last Name:CHISHOLM
Suffix:
Gender:F
Credentials:ATP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 S PARK DR STE A
Mailing Address - Street 2:
Mailing Address - City:BROWNWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:76801-5957
Mailing Address - Country:US
Mailing Address - Phone:325-643-3290
Mailing Address - Fax:325-643-3295
Practice Address - Street 1:118 S PARK DR STE A
Practice Address - Street 2:
Practice Address - City:BROWNWOOD
Practice Address - State:TX
Practice Address - Zip Code:76801-5957
Practice Address - Country:US
Practice Address - Phone:325-643-3290
Practice Address - Fax:325-643-3295
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-01
Last Update Date:2019-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other