Healthcare Provider Details

I. General information

NPI: 1588445050
Provider Name (Legal Business Name): SARA VARNELL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/11/2023
Last Update Date: 10/11/2023
Certification Date: 10/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2429 KEITH ST NW
CLEVELAND TN
37311-1310
US

IV. Provider business mailing address

119 BIRCHWOOD LN
CROSSVILLE TN
38555-4189
US

V. Phone/Fax

Practice location:
  • Phone: 423-479-5808
  • Fax:
Mailing address:
  • Phone: 931-709-0661
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number1054
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: