Provider Demographics
NPI:1265032247
Name:JOHNSON, SARAH BETH (PA-C)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:BETH
Last Name:JOHNSON
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 1:6409 MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:TEXAS CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77591-4057
Mailing Address - Country:US
Mailing Address - Phone:409-935-2995
Mailing Address - Fax:409-935-3433
Practice Address - Street 1:6409 MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:TEXAS CITY
Practice Address - State:TX
Practice Address - Zip Code:77591-4057
Practice Address - Country:US
Practice Address - Phone:409-935-2995
Practice Address - Fax:409-935-3433
Is Sole Proprietor?:No
Enumeration Date:2020-10-28
Last Update Date:2022-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA14038363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical