Healthcare Provider Details

I. General information

NPI: 1992947568
Provider Name (Legal Business Name): SANDRA KILBURN DANIEL ACNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2009
Last Update Date: 01/24/2022
Certification Date: 01/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 MEDICAL CENTER BLVD
FAYETTEVILLE TN
37334-2684
US

IV. Provider business mailing address

910 HILLCREST ST
LAWRENCEBURG TN
38464-4048
US

V. Phone/Fax

Practice location:
  • Phone: 931-438-1100
  • Fax:
Mailing address:
  • Phone: 931-762-6875
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number14014
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberA158353
License Number StateIA
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number239300
License Number StateAZ
# 4
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number14014
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: