MEDICARE: SARA ANNE DEBERRY PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	PA12837	TX

General Provider Information

NPI Number	:	1316591514
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARA ANNE DEBERRY PA-C

Provider Business Mailing Address
First Line	:	3263 BILGLADE RD
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76133-1658
Country	:	US
Telephone Number	:	979-221-4667
Fax Number	:

Provider Business Practice Location Address
First Line	:	1000 HOUSTON ST
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76102-6415
Country	:	US
Telephone Number	:	817-336-0551
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/26/2019
Last Update Date	:	08/24/2021

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