Provider Demographics
NPI:1760113930
Name:WEBB, SOPHIA ROSE
Entity Type:Individual
Prefix:
First Name:SOPHIA
Middle Name:ROSE
Last Name:WEBB
Suffix:
Gender:F
Credentials:
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 209
Mailing Address - Street 2:
Mailing Address - City:CHURCH HILL
Mailing Address - State:TN
Mailing Address - Zip Code:37642-0209
Mailing Address - Country:US
Mailing Address - Phone:423-357-5341
Mailing Address - Fax:423-357-2231
Practice Address - Street 1:247 SILVER LAKE RD
Practice Address - Street 2:
Practice Address - City:CHURCH HILL
Practice Address - State:TN
Practice Address - Zip Code:37642-3516
Practice Address - Country:US
Practice Address - Phone:423-357-5341
Practice Address - Fax:423-357-2231
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-20
Last Update Date:2022-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN230272163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health