Provider Demographics
NPI:1114322302
Name:HENLEY, SARA (PA)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:HENLEY
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2005 FORT WORTH HWY STE 100
Mailing Address - Street 2:
Mailing Address - City:WEATHERFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76086-4780
Mailing Address - Country:US
Mailing Address - Phone:817-598-5625
Mailing Address - Fax:817-598-5626
Practice Address - Street 1:2005 FORT WORTH HWY STE 200
Practice Address - Street 2:
Practice Address - City:WEATHERFORD
Practice Address - State:TX
Practice Address - Zip Code:76086-4781
Practice Address - Country:US
Practice Address - Phone:817-598-5620
Practice Address - Fax:817-598-5621
Is Sole Proprietor?:No
Enumeration Date:2014-10-30
Last Update Date:2022-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA09505363AM0700X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical