Healthcare Provider Details

I. General information

NPI: 1982820080
Provider Name (Legal Business Name): SARAH KELLI JOHNSON P.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SARAH KELLI BRADSHAW P.A.

II. Dates (important events)

Enumeration Date: 04/17/2007
Last Update Date: 12/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 HOSPITAL DR SUITE 2A
HENDERSONVILLE NC
28792-5248
US

IV. Provider business mailing address

PO BOX 1869
FLETCHER NC
28732-1869
US

V. Phone/Fax

Practice location:
  • Phone: 828-654-6015
  • Fax: 828-687-6058
Mailing address:
  • Phone: 828-687-5616
  • Fax: 828-650-8076

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number103965
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: