Healthcare Provider Details

I. General information

NPI: 1275285520
Provider Name (Legal Business Name): SARAH CASOLA PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2022
Last Update Date: 01/31/2024
Certification Date: 01/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4358 LOCKHILL SELMA RD STE 307
SHAVANO PARK TX
78249-4167
US

IV. Provider business mailing address

10807 PERRIN BEITEL RD
SAN ANTONIO TX
78217-3143
US

V. Phone/Fax

Practice location:
  • Phone: 210-245-7862
  • Fax:
Mailing address:
  • Phone: 210-245-7862
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number1067250
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: