Basic Information
| Provider Information | |||||||||
| NPI: | 1164827218 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GENTRY | ||||||||
| FirstName: | SABRA | ||||||||
| MiddleName: | SWAIMS | ||||||||
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| Credential: | FNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 176 | ||||||||
| Address2: | |||||||||
| City: | CARTHAGE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 370300176 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6157350700 | ||||||||
| FaxNumber: | 6157355480 | ||||||||
| Practice Location | |||||||||
| Address1: | 133 HOSPITAL DR | ||||||||
| Address2: | SUITE 500 | ||||||||
| City: | CARTHAGE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 370304004 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6157350700 | ||||||||
| FaxNumber: | 6157355480 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/31/2014 | ||||||||
| LastUpdateDate: | 10/31/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 18176 | TN | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 18176 | 01 | TN | APN LICENSE | OTHER |