Healthcare Provider Details

I. General information

NPI: 1053308130
Provider Name (Legal Business Name): SARAH MYNATT APRN, BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

920 MADISON AVE SUITE 520
MEMPHIS TN
38163-0001
US

IV. Provider business mailing address

7504 APPLE VALLEY RD
GERMANTOWN TN
38138-2147
US

V. Phone/Fax

Practice location:
  • Phone: 901-448-1584
  • Fax: 901-448-4121
Mailing address:
  • Phone: 901-755-5688
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberAPN0000005033
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: