Provider Demographics
NPI:1629388079
Name:HILDRETH, SARA A (PA-C)
Entity Type:Individual
Prefix:MS
First Name:SARA
Middle Name:A
Last Name:HILDRETH
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:A
Other - Last Name:ALBERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:PO BOX 8035
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67208-0035
Mailing Address - Country:US
Mailing Address - Phone:316-689-9135
Mailing Address - Fax:316-689-9667
Practice Address - Street 1:9415 E HARRY ST STE 202
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67207-5076
Practice Address - Country:US
Practice Address - Phone:316-691-0309
Practice Address - Fax:316-691-0881
Is Sole Proprietor?:No
Enumeration Date:2010-10-19
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS15-01433363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
003719269OtherMEDICARE
P01213883OtherRR MEDICARE
KS200688210BMedicaid