Provider Demographics
NPI:1275631848
Name:BUTELL, SARAH E (PA)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:E
Last Name:BUTELL
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:E
Other - Last Name:BASORE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:20375 W 151ST ST
Mailing Address - Street 2:SUITE 251
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66061-8702
Mailing Address - Country:US
Mailing Address - Phone:913-393-4888
Mailing Address - Fax:913-164-6884
Practice Address - Street 1:20375 W 151ST ST
Practice Address - Street 2:SUITE 251
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66061-8702
Practice Address - Country:US
Practice Address - Phone:913-393-4888
Practice Address - Fax:913-164-6884
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2016-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS15-00807363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100449960BMedicaid
KS100449960BMedicaid
KS033D00060Medicare PIN