=====================================================
General NPI Number Information
=====================================================
NPI Number | 1245600261
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SOPHIA NOBLE FNP-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/02/2015
-----------------------------------------------------
Last Update Date | 04/02/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2855 STAGE VILLAGE CV STE 5
-----------------------------------------------------
City | BARTLETT
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 38134-4616
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 901-245-1975
-----------------------------------------------------
Fax | 901-688-2098
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8767 BECCA PT
-----------------------------------------------------
City | CORDOVA
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 38016-1629
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 901-830-8850
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 20433
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------