Provider Demographics
NPI:1114174984
Name:MCQUEEN, SARAH BETH (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:BETH
Last Name:MCQUEEN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MRS
Other - First Name:SARAH
Other - Middle Name:BETH
Other - Last Name:LOVEGROVE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:107 S MAIN ST
Mailing Address - Street 2:P.O. BOX 540
Mailing Address - City:JELLICO
Mailing Address - State:TN
Mailing Address - Zip Code:37762-2154
Mailing Address - Country:US
Mailing Address - Phone:423-784-8492
Mailing Address - Fax:423-784-8358
Practice Address - Street 1:402 CUMBERLAND AVE
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:KY
Practice Address - Zip Code:40769-1238
Practice Address - Country:US
Practice Address - Phone:423-784-5771
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-25
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1638363A00000X
KYTC043363A00000X
KY1157363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1157OtherSTATE LICENSE
TN1638OtherSTATE LICENSE
KY0297025OtherKY MEDICARE
TN36652981OtherTN MEDICARE
TN3665298OtherTN MEDICARE
TN1511676Medicaid
KY7100180060Medicaid
KY7100180060Medicaid