MEDICARE: SARAH SHEA CROOK PHYSICIAN ASSISTANT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AM0700X	Medical Physician Assistant	0110005045	VA
2	363AM0700X	Medical Physician Assistant	2467	TN

General Provider Information

NPI Number	:	1841611357
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARAH SHEA CROOK PHYSICIAN ASSISTANT

Provider Business Mailing Address
First Line	:	1021 W OAKLAND AVE STE 310
Second Line	:
City	:	JOHNSON CITY
State	:	TN
Zip	:	37604-2192
Country	:	US
Telephone Number	:	423-302-6565
Fax Number	:

Provider Business Practice Location Address
First Line	:	405 SCENIC DR STE A
Second Line	:
City	:	ROGERSVILLE
State	:	TN
Zip	:	37857-2441
Country	:	US
Telephone Number	:	423-921-3490
Fax Number	:	423-272-7667

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/31/2013
Last Update Date	:	02/29/2024

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