Provider Demographics
NPI:1053569400
Name:CHISM, VALERIE DIANE (APN)
Entity type:Individual
Prefix:
First Name:VALERIE
Middle Name:DIANE
Last Name:CHISM
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61 CENTER SCHOOL RD
Mailing Address - Street 2:
Mailing Address - City:HATTIEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72063-8989
Mailing Address - Country:US
Mailing Address - Phone:501-289-0486
Mailing Address - Fax:
Practice Address - Street 1:4301 W MARKHAM ST
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-7101
Practice Address - Country:US
Practice Address - Phone:501-686-6337
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-28
Last Update Date:2008-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA03158 ANP363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care