Provider Demographics
NPI:1124899158
Name:PASTRICK, SOPHIA MARIE (FNP-C)
Entity type:Individual
Prefix:
First Name:SOPHIA
Middle Name:MARIE
Last Name:PASTRICK
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4917 LEXINGTON LN
Mailing Address - Street 2:
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37664-6520
Mailing Address - Country:US
Mailing Address - Phone:423-782-6005
Mailing Address - Fax:
Practice Address - Street 1:1 SHERIDAN SQ
Practice Address - Street 2:
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37660-7391
Practice Address - Country:US
Practice Address - Phone:423-392-4884
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-09
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN35004363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty