Healthcare Provider Details

I. General information

NPI: 1770893851
Provider Name (Legal Business Name): SHARON SHAYE MITCHELL RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/07/2010
Last Update Date: 10/07/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

927 E BADDOUR PKWY
LEBANON TN
37087-3706
US

IV. Provider business mailing address

927 E BADDOUR PKWY
LEBANON TN
37087-3706
US

V. Phone/Fax

Practice location:
  • Phone: 615-444-5325
  • Fax: 615-444-2750
Mailing address:
  • Phone: 615-444-5325
  • Fax: 615-444-2750

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License NumberRN0000162620
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: