Basic Information
Provider Information
NPI: 1841610896
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: STEPHENSON
FirstName: SARAH
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: FNP-BC
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName: WILSON
OtherFirstName: SARAH
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType: 1
Mailing Information
Address1: 1275 DICK LONAS RD UNIT 101
Address2:  
City: KNOXVILLE
State: TN
PostalCode: 379091383
CountryCode: US
TelephoneNumber: 8655844747
FaxNumber: 8655841363
Practice Location
Address1: 8975 EXECUTIVE PARK DR STE 200
Address2:  
City: KNOXVILLE
State: TN
PostalCode: 379234727
CountryCode: US
TelephoneNumber: 8656914100
FaxNumber: 8656916178
Other Information
ProviderEnumerationDate: 04/17/2014
LastUpdateDate: 11/08/2019
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LF0000X18309TNY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily

No ID Information.


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