Healthcare Provider Details

I. General information

NPI: 1619777851
Provider Name (Legal Business Name): SARAH CRUMP AGACNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/17/2025
Last Update Date: 07/02/2025
Certification Date: 07/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4618 MARLIE CIR NW
CLEVELAND TN
37312-4114
US

IV. Provider business mailing address

4618 MARLIE CIR NW
CLEVELAND TN
37312-4114
US

V. Phone/Fax

Practice location:
  • Phone: 423-716-0368
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number242578
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number39049
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: