Provider Demographics
NPI:1073814356
Name:EK, SADIE ANN (NP)
Entity Type:Individual
Prefix:
First Name:SADIE
Middle Name:ANN
Last Name:EK
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1508 TIMBER RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:EULESS
Mailing Address - State:TX
Mailing Address - Zip Code:76039-2549
Mailing Address - Country:US
Mailing Address - Phone:817-455-7233
Mailing Address - Fax:
Practice Address - Street 1:1508 TIMBER RIDGE DR
Practice Address - Street 2:
Practice Address - City:EULESS
Practice Address - State:TX
Practice Address - Zip Code:76039-2549
Practice Address - Country:US
Practice Address - Phone:817-455-7233
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-03
Last Update Date:2012-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX688625363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX284493802Medicaid
TX284493801Medicaid
TX688625OtherTEXAS BOARD OF NURSING
TX284493803Medicaid
TXTXB132220Medicare PIN
TX688625OtherTEXAS BOARD OF NURSING
TX284493801Medicaid