Provider Demographics
NPI:1639102791
Name:JOOMA, KHAIRUNNISSA (DNP/PMHNP-BC/LPC)
Entity Type:Individual
Prefix:DR
First Name:KHAIRUNNISSA
Middle Name:
Last Name:JOOMA
Suffix:
Gender:F
Credentials:DNP/PMHNP-BC/LPC
Other - Prefix:
Other - First Name:KHAIRUNNISSA
Other - Middle Name:
Other - Last Name:JOOMA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DNP/PMHNP-BC/LPC
Mailing Address - Street 1:91 HARBOR POINTE WAY
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37922-5154
Mailing Address - Country:US
Mailing Address - Phone:865-684-0900
Mailing Address - Fax:
Practice Address - Street 1:2205 MCCALLIE AVE
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37404-3230
Practice Address - Country:US
Practice Address - Phone:423-697-8385
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-09
Last Update Date:2019-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLPC 1953101YP2500X
TNAPN0000013348363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN5441854Medicaid
TNP00967911OtherRAILROAD MEDICARE
TNP00967911OtherRAILROAD MEDICARE