Provider Demographics
NPI:1588023766
Name:WILLIAMS, SARA (AGPCNP)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:AGPCNP
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:AGPCNP
Mailing Address - Street 1:1923 WAYBRIDGE LN
Mailing Address - Street 2:
Mailing Address - City:FENTON
Mailing Address - State:MO
Mailing Address - Zip Code:63026-5425
Mailing Address - Country:US
Mailing Address - Phone:314-261-6761
Mailing Address - Fax:
Practice Address - Street 1:1923 WAYBRIDGE LN
Practice Address - Street 2:
Practice Address - City:FENTON
Practice Address - State:MO
Practice Address - Zip Code:63026-5425
Practice Address - Country:US
Practice Address - Phone:314-261-6761
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-17
Last Update Date:2016-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2015033113363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care