Healthcare Provider Details

I. General information

NPI: 1952490708
Provider Name (Legal Business Name): SARAH Y B KEHOE PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SARAH Y B WALTERS PA-C

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 12/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

185 E PARKS HWY
WASILLA AK
99654-7038
US

IV. Provider business mailing address

185 E PARKS HWY
WASILLA AK
99654-7038
US

V. Phone/Fax

Practice location:
  • Phone: 907-373-4200
  • Fax:
Mailing address:
  • Phone: 907-733-3535
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberAA431
License Number StateAK
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: