Provider Demographics
NPI:1053662650
Name:FITZSIMMONS, SARAH LYNN (PA-C)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:LYNN
Last Name:FITZSIMMONS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:353 FAIRMONT BLVD
Mailing Address - Street 2:ATTEN CHRISTIE MSS
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57701-7375
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:890 LAZELLE ST
Practice Address - Street 2:
Practice Address - City:STURGIS
Practice Address - State:SD
Practice Address - Zip Code:57785-1611
Practice Address - Country:US
Practice Address - Phone:605-720-2600
Practice Address - Fax:605-720-2601
Is Sole Proprietor?:No
Enumeration Date:2012-09-24
Last Update Date:2013-02-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SD0830363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant