Provider Demographics
NPI:1164618633
Name:SARGENT, RACHEL MARIE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:RACHEL
Middle Name:MARIE
Last Name:SARGENT
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 1:600 N. GIANT CITY RD
Mailing Address - Street 2:
Mailing Address - City:CARBONDALE
Mailing Address - State:IL
Mailing Address - Zip Code:62902-6413
Mailing Address - Country:US
Mailing Address - Phone:618-549-2500
Mailing Address - Fax:618-549-2525
Practice Address - Street 1:600 N. GIANT CITY RD
Practice Address - Street 2:
Practice Address - City:CARBONDALE
Practice Address - State:IL
Practice Address - Zip Code:62902-6413
Practice Address - Country:US
Practice Address - Phone:618-549-2500
Practice Address - Fax:618-549-2525
Is Sole Proprietor?:No
Enumeration Date:2007-09-19
Last Update Date:2014-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085003056363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL208554OtherHEALTH ALLIANCE
ILCF3444OtherMEDICARE RR
IL370966854017Medicaid
IL640701Medicare Oscar/Certification
IL208554OtherHEALTH ALLIANCE
IL141970Medicare Oscar/Certification