Provider Demographics
NPI:1407180029
Name:ADDISON, SARA ADAMS (APN)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:ADAMS
Last Name:ADDISON
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2150 LAKESIDE BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75082-4302
Mailing Address - Country:US
Mailing Address - Phone:972-437-4698
Mailing Address - Fax:972-690-9309
Practice Address - Street 1:2150 LAKESIDE BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75082-4302
Practice Address - Country:US
Practice Address - Phone:972-437-4698
Practice Address - Fax:972-690-9309
Is Sole Proprietor?:No
Enumeration Date:2009-09-29
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX692182363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX692182OtherRN LICENSE
TXMR2081937OtherDEA