Healthcare Provider Details

I. General information

NPI: 1760049183
Provider Name (Legal Business Name): MRS. SARA D EAKER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2019
Last Update Date: 05/19/2022
Certification Date: 05/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10201 HIGHWAY 16
COMANCHE TX
76442-4462
US

IV. Provider business mailing address

10201 HIGHWAY 16
COMANCHE TX
76442-4462
US

V. Phone/Fax

Practice location:
  • Phone: 254-879-4910
  • Fax:
Mailing address:
  • Phone: 254-879-4910
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: