Healthcare Provider Details

I. General information

NPI: 1770866139
Provider Name (Legal Business Name): SARAH THOMAS HUTCHINSON PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SARAH THOMAS

II. Dates (important events)

Enumeration Date: 09/22/2011
Last Update Date: 11/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7829 YOUREE DR
SHREVEPORT LA
71105-5505
US

IV. Provider business mailing address

7829 YOUREE DR P.O. BOX 52598
SHREVEPORT LA
71105-5505
US

V. Phone/Fax

Practice location:
  • Phone: 318-797-8777
  • Fax: 318-797-7006
Mailing address:
  • Phone: 318-797-8777
  • Fax: 318-797-7006

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA.200478
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: