Healthcare Provider Details

I. General information

NPI: 1336176510
Provider Name (Legal Business Name): SARAH CAVANAGH WALKER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2006
Last Update Date: 01/23/2020
Certification Date: 01/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 COBURG RD
EUGENE OR
97401-4995
US

IV. Provider business mailing address

1292 HIGH ST STE 224
EUGENE OR
97401-3238
US

V. Phone/Fax

Practice location:
  • Phone: 541-640-7625
  • Fax:
Mailing address:
  • Phone: 541-500-2500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number160
License Number StateMT
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number101247
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number101247
License Number StateNC
# 4
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA193225
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
IdentifierNCM603D
Identifier TypeOTHER
Identifier StateNC
Identifier IssuerMEDICARE PTAN
# 2
IdentifierNCM603C
Identifier TypeOTHER
Identifier StateNC
Identifier IssuerMEDICARE PTAN
# 3
Identifier0000431477
Identifier TypeMEDICAID
Identifier StateMT
Identifier Issuer
# 4
IdentifierNCM603A
Identifier TypeOTHER
Identifier StateNC
Identifier IssuerMEDICARE PTAN
# 5
IdentifierNCM603B
Identifier TypeOTHER
Identifier StateNC
Identifier IssuerMEDICARE PTAN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: