Provider Demographics
NPI:1851331540
Name:BOOZER, SHERRIL M (RN, MSN, APN, FNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:SHERRIL
Middle Name:M
Last Name:BOOZER
Suffix:
Gender:F
Credentials:RN, MSN, APN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1710 PERSIMMON LN
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37922-7127
Mailing Address - Country:US
Mailing Address - Phone:865-659-7731
Mailing Address - Fax:
Practice Address - Street 1:10810 PARKSIDE DR
Practice Address - Street 2:PHYSICIANS PLAZA 1, SUITE 305
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37934-1979
Practice Address - Country:US
Practice Address - Phone:865-694-9676
Practice Address - Fax:865-588-3742
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2019-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN7217363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3349438Medicaid
TN3349438Medicaid
S62231Medicare UPIN
TN3349438OtherMEDICARE - PTAN
TN3734041Medicare PIN