MEDICARE: SARAH WITHERS RN

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	363L00000X	Nurse Practitioner	1169621	TX

General Provider Information

NPI Number	:	1801515358
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARAH WITHERS RN

Provider Business Mailing Address
First Line	:	1100 E LAKE ST STE 260
Second Line	:
City	:	TYLER
State	:	TX
Zip	:	75701-3359
Country	:	US
Telephone Number	:	903-590-5700
Fax Number	:

Provider Business Practice Location Address
First Line	:	1100 E LAKE ST STE 260
Second Line	:
City	:	TYLER
State	:	TX
Zip	:	75701-3359
Country	:	US
Telephone Number	:	903-590-5700
Fax Number	:

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

Provider Enumeration Date	:	08/25/2022
Last Update Date	:	08/16/2024

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