Healthcare Provider Details

I. General information

NPI: 1699700922
Provider Name (Legal Business Name): SANDRA MCCRARY PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2050 MEADOWVIEW PKWY
KINGSPORT TN
37660-7332
US

IV. Provider business mailing address

2050 MEADOWVIEW PKWY
KINGSPORT TN
37660-7332
US

V. Phone/Fax

Practice location:
  • Phone: 423-230-5000
  • Fax: 423-230-5010
Mailing address:
  • Phone: 423-230-5000
  • Fax: 423-230-5010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number024
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: