Healthcare Provider Details

I. General information

NPI: 1740754886
Provider Name (Legal Business Name): SARAH OPAL LYNN WATTS PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SARAH OPAL LYNN ARTHUR PA

II. Dates (important events)

Enumeration Date: 01/11/2019
Last Update Date: 07/31/2024
Certification Date: 07/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 CAHILL RD STE 206
BRANSON MO
65616-1911
US

IV. Provider business mailing address

PO BOX 505673
SAINT LOUIS MO
63150-5673
US

V. Phone/Fax

Practice location:
  • Phone: 417-348-8100
  • Fax: 417-348-8104
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number2019002627
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: