Healthcare Provider Details

I. General information

NPI: 1871301325
Provider Name (Legal Business Name): SARAH ELIZABETH DEEL APRN-FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/30/2024
Last Update Date: 12/30/2024
Certification Date: 12/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

258 N LEVISA RD
MOUTHCARD KY
41548-8117
US

IV. Provider business mailing address

4712 BULL CREEK RD
GRUNDY VA
24614-6204
US

V. Phone/Fax

Practice location:
  • Phone: 606-835-2305
  • Fax:
Mailing address:
  • Phone: 276-477-0469
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024192045
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: