MEDICARE: MRS. SARA ANNE SKELTON RDH

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	124Q00000X	Dental Hygienist	DH5978	TN

General Provider Information

NPI Number	:	1376626986
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SARA ANNE SKELTON RDH

Provider Business Mailing Address
First Line	:	3425 N HENDERSON WAY
Second Line	:
City	:	CLARKSVILLE
State	:	TN
Zip	:	37042-8600
Country	:	US
Telephone Number	:	931-552-3701
Fax Number	:	931-552-3701

Provider Business Practice Location Address
First Line	:	4761 ANDREW JACKSON PKWY
Second Line	:
City	:	HERMITAGE
State	:	TN
Zip	:	37076-1354
Country	:	US
Telephone Number	:	615-885-3525
Fax Number	:

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

Provider Enumeration Date	:	10/24/2006
Last Update Date	:	07/08/2007

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