Healthcare Provider Details

I. General information

NPI: 1578963989
Provider Name (Legal Business Name): CARRIE SEXTON PAYNE CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CARRIE SEXTON CRNA

II. Dates (important events)

Enumeration Date: 09/04/2014
Last Update Date: 10/25/2022
Certification Date: 10/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7565 DANNAHER DR
POWELL TN
37849-4029
US

IV. Provider business mailing address

341 TRANE DR
KNOXVILLE TN
37919-6053
US

V. Phone/Fax

Practice location:
  • Phone: 865-859-8000
  • Fax:
Mailing address:
  • Phone: 865-588-0880
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number19147
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: