Healthcare Provider Details

I. General information

NPI: 1942355144
Provider Name (Legal Business Name): SHARON CAMPBELL MCCLARY R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/25/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

430 COLLEGE ST
NEWPORT TN
37821-3752
US

IV. Provider business mailing address

2180 TOBES CREEK RD
COSBY TN
37722-2004
US

V. Phone/Fax

Practice location:
  • Phone: 423-623-8733
  • Fax:
Mailing address:
  • Phone: 423-487-0479
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License NumberRN0000111791
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: