Healthcare Provider Details

I. General information

NPI: 1083951990
Provider Name (Legal Business Name): SARAH ELIZABETH CRIDER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/11/2013
Last Update Date: 01/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2401 S 31ST ST
TEMPLE TX
76508-0001
US

IV. Provider business mailing address

PO BOX 1491
COLUMBUS GA
31902-1491
US

V. Phone/Fax

Practice location:
  • Phone: 254-724-2111
  • Fax:
Mailing address:
  • Phone: 706-507-9209
  • Fax: 706-507-9249

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA08070
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: