Healthcare Provider Details

I. General information

NPI: 1740731801
Provider Name (Legal Business Name): SARA LYNN CLARK PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SARA ANN LYNN PA-C

II. Dates (important events)

Enumeration Date: 10/24/2016
Last Update Date: 03/31/2022
Certification Date: 03/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16 WOODBINE LN
DANVILLE PA
17821-8029
US

IV. Provider business mailing address

100 N ACADEMY AVE
DANVILLE PA
17822-4903
US

V. Phone/Fax

Practice location:
  • Phone: 570-271-6070
  • Fax: 570-271-5609
Mailing address:
  • Phone: 570-271-6144
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberMA058675
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberMA058675
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberOA003963
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: