Healthcare Provider Details

I. General information

NPI: 1710545348
Provider Name (Legal Business Name): SARAH JOHNSON HUFFMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SARAH BETH JOHNSON

II. Dates (important events)

Enumeration Date: 05/29/2019
Last Update Date: 05/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1925 W PARK DR
N WILKESBORO NC
28659-3564
US

IV. Provider business mailing address

1292 DRAGWAY RD
WILKESBORO NC
28697-8155
US

V. Phone/Fax

Practice location:
  • Phone: 336-903-0147
  • Fax:
Mailing address:
  • Phone: 336-973-3616
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5011754
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: