Provider Demographics
NPI:1114261005
Name:FORSEY, SARAH L (PA-C)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:L
Last Name:FORSEY
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 1:1775 E 4500 S
Mailing Address - Street 2:
Mailing Address - City:HOLLADAY
Mailing Address - State:UT
Mailing Address - Zip Code:84117-4257
Mailing Address - Country:US
Mailing Address - Phone:801-272-4408
Mailing Address - Fax:801-272-4441
Practice Address - Street 1:1775 E 4500 S
Practice Address - Street 2:
Practice Address - City:HOLLADAY
Practice Address - State:UT
Practice Address - Zip Code:84117-4257
Practice Address - Country:US
Practice Address - Phone:801-272-4408
Practice Address - Fax:801-272-4441
Is Sole Proprietor?:No
Enumeration Date:2012-11-16
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8489478-1206363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTS7453289Medicaid
UT1144290479OtherNPI
UTS7453290Medicaid