Provider Demographics
NPI:1114279031
Name:PATRICK, SARAH R (FNP-BC)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:R
Last Name:PATRICK
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:R
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-BC
Mailing Address - Street 1:686 S PIKE ST
Mailing Address - Street 2:A
Mailing Address - City:SHINNSTON
Mailing Address - State:WV
Mailing Address - Zip Code:26431-1043
Mailing Address - Country:US
Mailing Address - Phone:304-592-2100
Mailing Address - Fax:
Practice Address - Street 1:686 S PIKE ST
Practice Address - Street 2:
Practice Address - City:SHINNSTON
Practice Address - State:WV
Practice Address - Zip Code:26431-1043
Practice Address - Country:US
Practice Address - Phone:304-592-2100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-03
Last Update Date:2016-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV76151363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily