Provider Demographics
NPI:1154780757
Name:CHISM, MICHAEL K II (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:K
Last Name:CHISM
Suffix:II
Gender:M
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:15355 E COLFAX AVE UNIT 111717
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80042-1975
Mailing Address - Country:US
Mailing Address - Phone:720-507-4779
Mailing Address - Fax:720-367-5067
Practice Address - Street 1:2675 S ABILENE ST STE 100
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80014-2363
Practice Address - Country:US
Practice Address - Phone:720-507-4779
Practice Address - Fax:833-941-5047
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-11
Last Update Date:2024-08-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
COAPN.0992884-NP363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health