Provider Demographics
NPI:1881113652
Name:PARHAM, VIVIAN GRACE (MS RN AGPCNP)
Entity type:Individual
Prefix:
First Name:VIVIAN
Middle Name:GRACE
Last Name:PARHAM
Suffix:
Gender:F
Credentials:MS RN AGPCNP
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Mailing Address - Street 1:3475 BRAINERD RD STE B
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37411-3550
Mailing Address - Country:US
Mailing Address - Phone:423-800-8337
Mailing Address - Fax:423-760-8257
Practice Address - Street 1:3475 BRAINERD RD STE B
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37411-3550
Practice Address - Country:US
Practice Address - Phone:423-800-8337
Practice Address - Fax:423-760-8257
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-13
Last Update Date:2023-10-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY308301363LA2200X
TN34016363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health