Provider Demographics
NPI:1831474154
Name:PAYNE, SHARON KEY
Entity Type:Individual
Prefix:MS
First Name:SHARON
Middle Name:KEY
Last Name:PAYNE
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:SHARON
Other - Middle Name:A
Other - Last Name:PAYNE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NP
Mailing Address - Street 1:1066 RUTLEDGE PIKE
Mailing Address - Street 2:
Mailing Address - City:BLAINE
Mailing Address - State:TN
Mailing Address - Zip Code:37709-3027
Mailing Address - Country:US
Mailing Address - Phone:865-933-9477
Mailing Address - Fax:865-933-9466
Practice Address - Street 1:1066 RUTLEDGE PIKE
Practice Address - Street 2:
Practice Address - City:BLAINE
Practice Address - State:TN
Practice Address - Zip Code:37709-3027
Practice Address - Country:US
Practice Address - Phone:865-933-9477
Practice Address - Fax:865-933-9466
Is Sole Proprietor?:No
Enumeration Date:2011-10-18
Last Update Date:2011-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000016183363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily