Healthcare Provider Details

I. General information

NPI: 1871011437
Provider Name (Legal Business Name): SARA PORTWOOD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2017
Last Update Date: 09/05/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 DAMERON AVE.
KNOXVILLE TN
37917
US

IV. Provider business mailing address

1955 RIVER VISTA CIRCLE
SEVIERVILLE TN
37876
US

V. Phone/Fax

Practice location:
  • Phone: 865-215-5000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WW0101X
TaxonomyAmbulatory Women's Health Care Registered Nurse
License Number192448
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: