Basic Information
| Provider Information | |||||||||
| NPI: | 1811385206 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | THARPE | ||||||||
| FirstName: | SANDRA | ||||||||
| MiddleName: | JEAN | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | APN | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | THARPE | ||||||||
| OtherFirstName: | SANDRA | ||||||||
| OtherMiddleName: | OWENS | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | APN | ||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 710 CARL PERKINS PKWY | ||||||||
| Address2: | |||||||||
| City: | TIPTONVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 380791678 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7312536690 | ||||||||
| FaxNumber: | 7312536692 | ||||||||
| Practice Location | |||||||||
| Address1: | 130 N MAIN ST | ||||||||
| Address2: | |||||||||
| City: | RIDGELY | ||||||||
| State: | TN | ||||||||
| PostalCode: | 380801317 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7312645518 | ||||||||
| FaxNumber: | 7312649859 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/07/2015 | ||||||||
| LastUpdateDate: | 01/07/2015 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 19500 | TN | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.