Healthcare Provider Details

I. General information

NPI: 1659333508
Provider Name (Legal Business Name): SANDRA MCMAHAN BYRD CFNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2006
Last Update Date: 03/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

119 SUGARFOOT WAY
PIGEON FORGE TN
37863-6204
US

IV. Provider business mailing address

119 SUGARFOOT WAY
PIGEON FORGE TN
37863-6204
US

V. Phone/Fax

Practice location:
  • Phone: 865-453-9045
  • Fax: 865-428-0081
Mailing address:
  • Phone: 865-453-9045
  • Fax: 865-428-0081

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPN6074
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: