Basic Information
| Provider Information | |||||||||
| NPI: | 1801432281 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NETTLES | ||||||||
| FirstName: | SARAH | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | FNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 117 DARTMOUTH DR | ||||||||
| Address2: | |||||||||
| City: | BRISTOL | ||||||||
| State: | TN | ||||||||
| PostalCode: | 376203320 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4239439140 | ||||||||
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| Practice Location | |||||||||
| Address1: | 273 HIGHWAY 11 E | ||||||||
| Address2: | |||||||||
| City: | BULLS GAP | ||||||||
| State: | TN | ||||||||
| PostalCode: | 377113433 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4233934146 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/21/2019 | ||||||||
| LastUpdateDate: | 06/16/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/16/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 26712 | TN | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.