MEDICARE: SARA MCKINNISS 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	10004807A	IN
2	363AM0700X	Medical Physician Assistant	10004807A	IN

General Provider Information

NPI Number	:	1548944259
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARA MCKINNISS PA-C

Provider Business Mailing Address
First Line	:	8870 LOWELL ST
Second Line	:
City	:	MCCORDSVILLE
State	:	IN
Zip	:	46055-9825
Country	:	US
Telephone Number	:	217-821-2510
Fax Number	:

Provider Business Practice Location Address
First Line	:	8870 LOWELL ST
Second Line	:
City	:	MCCORDSVILLE
State	:	IN
Zip	:	46055-9825
Country	:	US
Telephone Number	:	217-821-2510
Fax Number	:

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

Provider Enumeration Date	:	06/13/2023
Last Update Date	:	06/16/2026

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Directions to “ SARA MCKINNISS PA-C” Practice Location

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