Provider Demographics
NPI:1659333508
Name:BYRD, SANDRA MCMAHAN (CFNP)
Entity Type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:MCMAHAN
Last Name:BYRD
Suffix:
Gender:F
Credentials:CFNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:119 SUGARFOOT WAY
Mailing Address - Street 2:
Mailing Address - City:PIGEON FORGE
Mailing Address - State:TN
Mailing Address - Zip Code:37863-6204
Mailing Address - Country:US
Mailing Address - Phone:865-453-9045
Mailing Address - Fax:865-428-0081
Practice Address - Street 1:119 SUGARFOOT WAY
Practice Address - Street 2:
Practice Address - City:PIGEON FORGE
Practice Address - State:TN
Practice Address - Zip Code:37863-6204
Practice Address - Country:US
Practice Address - Phone:865-453-9045
Practice Address - Fax:865-428-0081
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2019-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN6074363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3346101Medicaid
TNS76777Medicare UPIN
TN3370465Medicare ID - Type Unspecified