Provider Demographics
NPI:1003165960
Name:ASHMORE, SARAH COTTON (CRNA)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:COTTON
Last Name:ASHMORE
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:E
Other - Last Name:COTTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 3488, DEPT 05-004
Mailing Address - Street 2:
Mailing Address - City:TUPELO
Mailing Address - State:MS
Mailing Address - Zip Code:38803-3488
Mailing Address - Country:US
Mailing Address - Phone:662-377-4394
Mailing Address - Fax:662-377-7045
Practice Address - Street 1:830 SOUTH GLOSTER
Practice Address - Street 2:
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38801-4934
Practice Address - Country:US
Practice Address - Phone:662-377-4394
Practice Address - Fax:662-377-7045
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-06
Last Update Date:2016-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR877526367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered