Healthcare Provider Details

I. General information

NPI: 1114150455
Provider Name (Legal Business Name): SARA MCCOSKEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2009
Last Update Date: 05/16/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

697 LOUSIANN DR DYESS AFB TEXAS
ABILENE TX
79607
US

IV. Provider business mailing address

697 LOUSIANN DR DYESS AFB TEXAS
ABILENE TX
79607
US

V. Phone/Fax

Practice location:
  • Phone: 325-696-5490
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1710I1003X
TaxonomyIndependent Duty Medical Technicians
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: