Healthcare Provider Details

I. General information

NPI: 1487346136
Provider Name (Legal Business Name): SARAH LEANNE YORK APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2023
Last Update Date: 05/22/2023
Certification Date: 05/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2080 S FRONTAGE RD STE 107
VICKSBURG MS
39180-5882
US

IV. Provider business mailing address

9933 HAMAKUA ST
DIAMONDHEAD MS
39525-4433
US

V. Phone/Fax

Practice location:
  • Phone: 601-654-7070
  • Fax:
Mailing address:
  • Phone: 601-415-1379
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number905640
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: