Healthcare Provider Details

I. General information

NPI: 1316496904
Provider Name (Legal Business Name): SARA VERMA PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2016
Last Update Date: 09/24/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5959 PARK AVE
MEMPHIS TN
38119-5200
US

IV. Provider business mailing address

370 SOUTHWIND DR
MARION AR
72364-3004
US

V. Phone/Fax

Practice location:
  • Phone: 901-765-1000
  • Fax:
Mailing address:
  • Phone: 631-827-2920
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number3075
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number23 019954
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: