Healthcare Provider Details

I. General information

NPI: 1487343752
Provider Name (Legal Business Name): SARAH MARTIN PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2023
Last Update Date: 07/25/2024
Certification Date: 07/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1003 WINDOVER RD
JONESBORO AR
72401-6007
US

IV. Provider business mailing address

PO BOX 9178
RUSSELLVILLE AR
72811-9178
US

V. Phone/Fax

Practice location:
  • Phone: 870-336-1600
  • Fax: 870-336-0585
Mailing address:
  • Phone: 800-824-4094
  • Fax: 479-968-1673

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA-1170
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: