1053631713 NPI number — MS. SARAH A HONAKER FNP

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053631713 NPI number — MS. SARAH A HONAKER FNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HONAKER
Provider First Name:
SARAH
Provider Middle Name:
A
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
FNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1053631713
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/24/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5121 MARYLAND WAY STE 300
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BRENTWOOD
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37027-7516
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
629-206-3254
Provider Business Mailing Address Fax Number:
629-216-0568

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
435 2ND ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEWPORT
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37821-3703
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
629-206-3254
Provider Business Practice Location Address Fax Number:
629-216-0568
Provider Enumeration Date:
06/04/2010

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  APN0000014702 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: P00917893 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 1508879719 . This is a "GROUP NPI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 103I502527 . This is a "MEDICARE PTAN" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 1520254 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".




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