Healthcare Provider Details

I. General information

NPI: 1053022863
Provider Name (Legal Business Name): XAMAERA SHARECE HENRY CNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/13/2022
Last Update Date: 12/13/2022
Certification Date: 12/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

255 E WATT ST
ALCOA TN
37701-2236
US

IV. Provider business mailing address

1923 SULPHUR SPRINGS RD
MORRISTOWN TN
37813-5654
US

V. Phone/Fax

Practice location:
  • Phone: 865-273-1616
  • Fax: 865-273-1645
Mailing address:
  • Phone: 423-317-9344
  • Fax: 423-714-2355

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number202204
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: