MEDICARE: DR. SARAH MYNATT APRN, BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WP0808X	Psychiatric/Mental Health Registered Nurse	APN0000005033	TN

General Provider Information

NPI Number	:	1053308130
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SARAH MYNATT APRN, BC

Provider Business Mailing Address
First Line	:	7504 APPLE VALLEY RD
Second Line	:
City	:	GERMANTOWN
State	:	TN
Zip	:	38138-2147
Country	:	US
Telephone Number	:	901-755-5688
Fax Number	:

Provider Business Practice Location Address
First Line	:	920 MADISON AVE
Second Line	:	SUITE 520
City	:	MEMPHIS
State	:	TN
Zip	:	38163-0001
Country	:	US
Telephone Number	:	901-448-1584
Fax Number	:	901-448-4121

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/04/2005
Last Update Date	:	07/08/2007

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