Provider Demographics
NPI:1659977171
Name:PURNELL, RUBY SHERYL (NON MEDICAL PROVIDER)
Entity Type:Individual
Prefix:
First Name:RUBY
Middle Name:SHERYL
Last Name:PURNELL
Suffix:
Gender:F
Credentials:NON MEDICAL PROVIDER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5711 SUMMER GROVE LN
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37931-3721
Mailing Address - Country:US
Mailing Address - Phone:865-237-2490
Mailing Address - Fax:
Practice Address - Street 1:5711 SUMMER GROVE LN
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37931-3721
Practice Address - Country:US
Practice Address - Phone:865-237-2490
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-09
Last Update Date:2020-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3747A0650X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider