=====================================================
General NPI Number Information
=====================================================
NPI Number | 1912349283
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SARA K HERBERT FNP-BC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/26/2013
-----------------------------------------------------
Last Update Date | 09/17/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 851 E 5TH ST STE 208
-----------------------------------------------------
City | WASHINGTON
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63090-3129
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 636-239-8097
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 851 E 5TH ST STE 208
-----------------------------------------------------
City | WASHINGTON
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63090-3129
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 636-239-8097
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number | 2013027047
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 2013027047
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------