Provider Demographics
NPI:1740211937
Name:TRUMBLEY, SHARON G (WHNP)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:G
Last Name:TRUMBLEY
Suffix:
Gender:F
Credentials:WHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 70403
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37614-1703
Mailing Address - Country:US
Mailing Address - Phone:423-439-4078
Mailing Address - Fax:
Practice Address - Street 1:1901 S SHADY ST
Practice Address - Street 2:
Practice Address - City:MOUNTAIN CITY
Practice Address - State:TN
Practice Address - Zip Code:37683-2021
Practice Address - Country:US
Practice Address - Phone:423-727-1150
Practice Address - Fax:423-727-1152
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2008-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN006383363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNJOHN DEEREOtherTN01C3
TN133278OtherBLUECROSSBLUESHIELD
TN3908051Medicaid
TN100036752OtherPHP
P15990Medicare UPIN
TNJOHN DEEREOtherTN01C3
TN3908051Medicare PIN