Provider Demographics
NPI:1538900071
Name:RUSSELL, SYDNEY (APRN)
Entity type:Individual
Prefix:
First Name:SYDNEY
Middle Name:
Last Name:RUSSELL
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:SYDNEY
Other - Middle Name:
Other - Last Name:SHOULDERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:200 HIGHWAY 52 BYP W
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:TN
Mailing Address - Zip Code:37083-1727
Mailing Address - Country:US
Mailing Address - Phone:615-688-2273
Mailing Address - Fax:
Practice Address - Street 1:200 HIGHWAY 52 BYP W
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:TN
Practice Address - Zip Code:37083-1727
Practice Address - Country:US
Practice Address - Phone:615-688-2273
Practice Address - Fax:615-688-2271
Is Sole Proprietor?:No
Enumeration Date:2024-06-06
Last Update Date:2025-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN241526163W00000X
TN37295363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse