Provider Demographics
NPI:1578954343
Name:TIPTON, SARA JANE (PA-C)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:JANE
Last Name:TIPTON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:621 S NEW BALLAS RD STE 3005B
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-8266
Mailing Address - Country:US
Mailing Address - Phone:314-251-7070
Mailing Address - Fax:
Practice Address - Street 1:621 S NEW BALLAS RD STE 3005B
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-8266
Practice Address - Country:US
Practice Address - Phone:314-251-7070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-13
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2015004456363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical