MEDICARE: SARA JEAN WARD APRN

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	363L00000X	Nurse Practitioner	37478	TN

General Provider Information

NPI Number	:	1679389613
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARA JEAN WARD APRN

Provider Business Mailing Address
First Line	:	2112 HENDON RD
Second Line	:
City	:	SODDY DAISY
State	:	TN
Zip	:	37379-2809
Country	:	US
Telephone Number	:	423-326-8819
Fax Number	:

Provider Business Practice Location Address
First Line	:	721 GLENWOOD DR STE W550
Second Line	:
City	:	CHATTANOOGA
State	:	TN
Zip	:	37404-1155
Country	:	US
Telephone Number	:	423-698-8692
Fax Number	:

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

Provider Enumeration Date	:	12/04/2024
Last Update Date	:	12/04/2024

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