Provider Demographics
NPI:1013758788
Name:BOLL, BRIGITTE MICHELLE (PMHNP, BC)
Entity type:Individual
Prefix:
First Name:BRIGITTE
Middle Name:MICHELLE
Last Name:BOLL
Suffix:
Gender:
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 1:65 GERMANTOWN CT STE 207
Mailing Address - Street 2:
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38018-4258
Mailing Address - Country:US
Mailing Address - Phone:901-878-3332
Mailing Address - Fax:
Practice Address - Street 1:159 DARLENE DR
Practice Address - Street 2:STE 205
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37042-4204
Practice Address - Country:US
Practice Address - Phone:931-538-3331
Practice Address - Fax:901-350-7790
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-05
Last Update Date:2025-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000195038163W00000X
TN36512363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse