Provider Demographics
NPI:1326428087
Name:MINCEY, SANDRA ELLA HUMPHREY (FNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:ELLA HUMPHREY
Last Name:MINCEY
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 OLD WEISGARBER RD
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37909-1291
Mailing Address - Country:US
Mailing Address - Phone:865-584-2146
Mailing Address - Fax:
Practice Address - Street 1:MCNEELEY FAMILY PHYSICIANS
Practice Address - Street 2:110 EXECUTIVE PARK DRIVE
Practice Address - City:CLINTON
Practice Address - State:TN
Practice Address - Zip Code:37716
Practice Address - Country:US
Practice Address - Phone:865-494-9241
Practice Address - Fax:865-494-0895
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-08
Last Update Date:2020-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN19964363LF0000X
TN20210308163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ015005Medicaid
TN1035I07327Medicare PIN