Healthcare Provider Details

I. General information

NPI: 1578164836
Provider Name (Legal Business Name): SARAH ANDERSON PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/03/2020
Last Update Date: 02/26/2024
Certification Date: 02/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9990 DALLAS PKWY STE 125
FRISCO TX
75033-4137
US

IV. Provider business mailing address

4250 E RENNER RD APT 1723
RICHARDSON TX
75082-2851
US

V. Phone/Fax

Practice location:
  • Phone: 817-337-6604
  • Fax: 817-337-6866
Mailing address:
  • Phone: 708-420-5099
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA13761
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: