Healthcare Provider Details

I. General information

NPI: 1588477004
Provider Name (Legal Business Name): KATHRYN BLAIR SEWELL FNP -C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/29/2025
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 SKIDAWAY VILLAGE WALK STE B
SAVANNAH GA
31411-2962
US

IV. Provider business mailing address

PO BOX 13686
SAVANNAH GA
31416-0686
US

V. Phone/Fax

Practice location:
  • Phone: 912-598-6312
  • Fax:
Mailing address:
  • Phone: 912-598-6312
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number198703
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: