Provider Demographics
NPI:1922522275
Name:CHISHOLM, CARYN JADE (PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:CARYN
Middle Name:JADE
Last Name:CHISHOLM
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10025 W MEADOWBROOK AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85037-5255
Mailing Address - Country:US
Mailing Address - Phone:602-502-6797
Mailing Address - Fax:
Practice Address - Street 1:10025 W MEADOWBROOK AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85037-5255
Practice Address - Country:US
Practice Address - Phone:602-502-6797
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP10395363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health