Karissa Nichole Chisum, PMHNP-BC

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

95024718 Issued in CA

Practice address

1640 Newport Blvd Ste 110
Costa Mesa, CA 92627-7762

Phone

(925) 282-1778

NPI assigned

Jul 27, 2023

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: lifestancehealth.karissachisum@148377.advancedmd-direct.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Pacific Coast Psychiatric Associates Inc

  • Clinical Psychologist
  • Scottsdale, AZ
  • NPI 1023125465

  CA, Single Specialty

  Medicare reassignment NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1690416000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1716508800000",
    "number": "1558042101",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1640 NEWPORT BLVD STE 110",
            "city": "COSTA MESA",
            "state": "CA",
            "postal_code": "926277762"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1640 NEWPORT BLVD STE 110",
            "city": "COSTA MESA",
            "state": "CA",
            "postal_code": "926277762",
            "telephone_number": "925-282-1778"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2900 bristol st",
            "address_2": "building h, st 201",
            "address_purpose": "LOCATION",
            "city": "costa mesa",
            "state": "CA",
            "postal_code": "92626",
            "country_code": "US",
            "telephone_number": "714-617-7556",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CHISUM",
        "first_name": "KARISSA",
        "middle_name": "NICHOLE",
        "credential": "PMHNP-BC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2023-07-27",
        "last_updated": "2024-05-24",
        "certification_date": "2024-05-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "CA",
            "license": "95082085",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "CA",
            "license": "95024718",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Victoria Chie Huang
• Childrens Hospital of Orange County
• Christian Mark Chipouras, DPT,MS
• Amanda Chisam
• Amna Amir Chishty
• Sarah Wing-Yin Chiu, MD
• Cho & Chun Optometry, Inc
• Donna Cho, R.N.
• Grace J Cho
• Lydia Cho

• Psychiatric/Mental Health Nurse Practitioner in Costa Mesa, CA
• Providers in Costa Mesa, CA by specialty
• Psychiatric/Mental Health Nurse Practitioner in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 24, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.