Healthcare Provider Details

I. General information

NPI: 1902870496
Provider Name (Legal Business Name): SUE DAVIS STROTHER FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/14/2006
Last Update Date: 11/20/2023
Certification Date: 11/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4980 ALPHA LN
HIXSON TN
37343-5470
US

IV. Provider business mailing address

4976 ALPHA LN
HIXSON TN
37343-5470
US

V. Phone/Fax

Practice location:
  • Phone: 423-870-2450
  • Fax: 423-877-5208
Mailing address:
  • Phone: 423-308-0280
  • Fax: 423-308-0281

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number05415
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: