Healthcare Provider Details

I. General information

NPI: 1962027102
Provider Name (Legal Business Name): SARAH SMITH KOBERLEIN RN, BSN, PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SARAH JESSICA SMITH RN, BSN

II. Dates (important events)

Enumeration Date: 06/13/2020
Last Update Date: 08/05/2020
Certification Date: 08/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2347 JONES BEND RD
LOUISVILLE TN
37777-5233
US

IV. Provider business mailing address

2347 JONES BEND RD
LOUISVILLE TN
37777-5213
US

V. Phone/Fax

Practice location:
  • Phone: 865-970-9800
  • Fax:
Mailing address:
  • Phone: 865-970-9800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number27661
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: