Provider Demographics
NPI:1053638304
Name:WHITE, SARAH L (PA-C)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:L
Last Name:WHITE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19272 STONE OAK PKWY STE 101
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-3372
Mailing Address - Country:US
Mailing Address - Phone:210-265-8851
Mailing Address - Fax:210-265-8855
Practice Address - Street 1:19272 STONE OAK PKWY STE 101
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-3372
Practice Address - Country:US
Practice Address - Phone:210-265-8851
Practice Address - Fax:210-265-8855
Is Sole Proprietor?:No
Enumeration Date:2010-04-27
Last Update Date:2014-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA03313363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXPA03313OtherSTATE LICENSE