Healthcare Provider Details

I. General information

NPI: 1437355542
Provider Name (Legal Business Name): SARA L WYRICK MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SARA R LEWIS

II. Dates (important events)

Enumeration Date: 06/25/2007
Last Update Date: 12/27/2024
Certification Date: 12/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4900 MUELLER BLVD
AUSTIN TX
78723-3079
US

IV. Provider business mailing address

8308 ELANDER DR
AUSTIN TX
78750-7842
US

V. Phone/Fax

Practice location:
  • Phone: 512-324-0150
  • Fax:
Mailing address:
  • Phone: 512-324-0150
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number25660
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code2080P0204X
TaxonomyPediatric Emergency Medicine (Pediatrics) Physician
License NumberP6938
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberP6938
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: