MEDICARE: KATHY R SORRELL RNC, FNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	RN42649	TN
2	363L00000X	Nurse Practitioner	APN5348	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	100011018	OTHER	TN	PHP TENNCARE
3	3032447	OTHER	TN	BCBST
4	3032446	OTHER	TN	BLUECARE-BOGARD

General Provider Information

NPI Number	:	1053381384
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHY R SORRELL RNC, FNP

Provider Business Mailing Address
First Line	:	103 WILTON SPRINGS ROAD
Second Line	:
City	:	NEWPORT
State	:	TN
Zip	:	37821-6405
Country	:	US
Telephone Number	:	423-487-2222
Fax Number	:	423-623-7787

Provider Business Practice Location Address
First Line	:	103 WILTON SPRINGS ROAD
Second Line	:
City	:	NEWPORT
State	:	TN
Zip	:	37821-6405
Country	:	US
Telephone Number	:	423-487-2222
Fax Number	:	423-623-7787

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/26/2006
Last Update Date	:	03/23/2010

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