Healthcare Provider Details

I. General information

NPI: 1972267540
Provider Name (Legal Business Name): SARA MEBRAHTU NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/28/2021
Last Update Date: 11/12/2022
Certification Date: 11/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

463 W SAM RIDLEY PKWY
SMYRNA TN
37167-5626
US

IV. Provider business mailing address

4585 XAVIER DR
ANTIOCH TN
37013-2762
US

V. Phone/Fax

Practice location:
  • Phone: 615-768-4258
  • Fax:
Mailing address:
  • Phone: 615-705-1973
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN0000030643
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: