Healthcare Provider Details

I. General information

NPI: 1053004440
Provider Name (Legal Business Name): SARAH DREHER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2023
Last Update Date: 04/02/2025
Certification Date: 04/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 12TH AVE STE 102
FORT WORTH TX
76104-3926
US

IV. Provider business mailing address

129 ATHENIA DR UNIT 131
FORT WORTH TX
76114-4301
US

V. Phone/Fax

Practice location:
  • Phone: 817-725-7880
  • Fax:
Mailing address:
  • Phone: 501-681-2908
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: