Healthcare Provider Details

I. General information

NPI: 1093358509
Provider Name (Legal Business Name): SANDY S NICHOLS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/28/2019
Last Update Date: 10/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2302 WINDEMERE WAY
NEW MARKET TN
37820-5251
US

IV. Provider business mailing address

2302 WINDEMERE WAY
NEW MARKET TN
37820-5251
US

V. Phone/Fax

Practice location:
  • Phone: 865-851-4525
  • Fax:
Mailing address:
  • Phone: 865-851-4525
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number1000000025336
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: