Provider Demographics
NPI:1164030367
Name:SAMMONS, SARA ANN (FNP-C)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:ANN
Last Name:SAMMONS
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:ANN
Other - Last Name:COSTLY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:PO BOX 15004
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37901-5004
Mailing Address - Country:US
Mailing Address - Phone:865-541-8895
Mailing Address - Fax:865-633-4808
Practice Address - Street 1:1115 BLANTON DR
Practice Address - Street 2:
Practice Address - City:SEVIERVILLE
Practice Address - State:TN
Practice Address - Zip Code:37862-5050
Practice Address - Country:US
Practice Address - Phone:865-453-4434
Practice Address - Fax:866-610-2903
Is Sole Proprietor?:No
Enumeration Date:2020-07-14
Last Update Date:2023-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN30110363LF0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ069500Medicaid