Provider Demographics
NPI:1285861047
Name:LILES, SARAH ANN (ANP)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:ANN
Last Name:LILES
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:ANN
Other - Last Name:PICKERING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ANP
Mailing Address - Street 1:3801 N. LAMAR BLVD., SUITE 300
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78756
Mailing Address - Country:US
Mailing Address - Phone:512-421-3869
Mailing Address - Fax:512-407-1873
Practice Address - Street 1:3801 N. LAMAR BLVD., SUITE 300
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78756
Practice Address - Country:US
Practice Address - Phone:512-421-3869
Practice Address - Fax:512-407-1873
Is Sole Proprietor?:No
Enumeration Date:2009-06-18
Last Update Date:2019-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN266490363L00000X
OR200950031NP363L00000X, 363LA2200X
TXAP141831363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500613532Medicaid
ORR160861Medicare PIN
OR500613532Medicaid