Healthcare Provider Details

I. General information

NPI: 1003165960
Provider Name (Legal Business Name): SARAH COTTON ASHMORE CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SARAH E COTTON

II. Dates (important events)

Enumeration Date: 09/06/2012
Last Update Date: 11/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

830 SOUTH GLOSTER
TUPELO MS
38801-4934
US

IV. Provider business mailing address

PO BOX 3488, DEPT 05-004
TUPELO MS
38803-3488
US

V. Phone/Fax

Practice location:
  • Phone: 662-377-4394
  • Fax: 662-377-7045
Mailing address:
  • Phone: 662-377-4394
  • Fax: 662-377-7045

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberR877526
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: