Provider Demographics
NPI:1417329129
Name:MATA, SARAH JO (NP-C)
Entity Type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:JO
Last Name:MATA
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1412 N 2ND ST
Mailing Address - Street 2:
Mailing Address - City:ATCHISON
Mailing Address - State:KS
Mailing Address - Zip Code:66002-1203
Mailing Address - Country:US
Mailing Address - Phone:913-367-4879
Mailing Address - Fax:913-367-0240
Practice Address - Street 1:1412 N 2ND ST
Practice Address - Street 2:
Practice Address - City:ATCHISON
Practice Address - State:KS
Practice Address - Zip Code:66002-1203
Practice Address - Country:US
Practice Address - Phone:913-367-4879
Practice Address - Fax:913-360-0240
Is Sole Proprietor?:No
Enumeration Date:2015-10-21
Last Update Date:2023-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS76975363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS201125060AMedicaid