Provider Demographics
NPI:1114382785
Name:BIGHAM, CORISSA (RN)
Entity type:Individual
Prefix:
First Name:CORISSA
Middle Name:
Last Name:BIGHAM
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1348 CARLTON RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38016-7604
Mailing Address - Country:US
Mailing Address - Phone:731-694-2175
Mailing Address - Fax:
Practice Address - Street 1:1348 CARLTON RIDGE DR
Practice Address - Street 2:
Practice Address - City:CORDOVA
Practice Address - State:TN
Practice Address - Zip Code:38016-7604
Practice Address - Country:US
Practice Address - Phone:731-694-2175
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-23
Last Update Date:2015-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRN0000191687163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse