Provider Demographics
NPI:1346611845
Name:WILMOT, SARA
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:WILMOT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3708 JEFFERSON ST
Mailing Address - Street 2:STE A
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78731-6206
Mailing Address - Country:US
Mailing Address - Phone:512-459-6503
Mailing Address - Fax:512-454-7453
Practice Address - Street 1:201 SETON PKWY
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78665-8000
Practice Address - Country:US
Practice Address - Phone:512-324-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-10
Last Update Date:2018-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA10111363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical