Provider Demographics
NPI:1275962102
Name:KING, SARA (NP)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:KING
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17645 WRIGHT ST STE 300
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68130-2195
Mailing Address - Country:US
Mailing Address - Phone:833-667-2967
Mailing Address - Fax:
Practice Address - Street 1:17645 WRIGHT ST STE 300
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68130-2195
Practice Address - Country:US
Practice Address - Phone:833-667-2967
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-01
Last Update Date:2021-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COC-APN.00002171-C-NP363LF0000X
CT9142363LF0000X
AZ257458363LF0000X
GAGAA-NP000005363LF0000X
IAA159557363LF0000X
IL209023024363LF0000X
IN71010263A363LF0000X
KS53-79574-082363LF0000X
KY3014741363LF0000X
MECNP201259363LF0000X
MI4704365611363LF0000X
MN7541363LF0000X
MO2020019955363LF0000X
NY347645363LF0000X
NE111605363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily