Provider Demographics
NPI:1992131932
Name:OWENS, SHERRY C (NP)
Entity type:Individual
Prefix:
First Name:SHERRY
Middle Name:C
Last Name:OWENS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1010 E 3RD ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37403-2109
Mailing Address - Country:US
Mailing Address - Phone:423-531-0001
Mailing Address - Fax:423-531-0002
Practice Address - Street 1:1010 E 3RD ST
Practice Address - Street 2:SUITE 201
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37403-2109
Practice Address - Country:US
Practice Address - Phone:423-531-0001
Practice Address - Fax:423-531-0002
Is Sole Proprietor?:No
Enumeration Date:2013-09-23
Last Update Date:2015-07-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TN17907363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN452687190OtherTAX ID
TNQ008273Medicaid
TN1528534Medicaid
TN10350I0139Medicare UPIN