Healthcare Provider Details

I. General information

NPI: 1285861047
Provider Name (Legal Business Name): SARAH ANN LILES ANP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SARAH ANN PICKERING ANP

II. Dates (important events)

Enumeration Date: 06/18/2009
Last Update Date: 11/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3801 N. LAMAR BLVD., SUITE 300
AUSTIN TX
78756
US

IV. Provider business mailing address

3801 N. LAMAR BLVD., SUITE 300
AUSTIN TX
78756
US

V. Phone/Fax

Practice location:
  • Phone: 512-421-3869
  • Fax: 512-407-1873
Mailing address:
  • Phone: 512-421-3869
  • Fax: 512-407-1873

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN266490
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number200950031NP
License Number StateOR
# 3
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number200950031NP
License Number StateOR
# 4
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP141831
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: