Provider Demographics
NPI:1689445108
Name:WITCHER, SARA CAITLIN (CRNA)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:CAITLIN
Last Name:WITCHER
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:CAITLIN
Other - Last Name:KOERTH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 631456
Mailing Address - Street 2:
Mailing Address - City:NACOGDOCHES
Mailing Address - State:TX
Mailing Address - Zip Code:75963-1456
Mailing Address - Country:US
Mailing Address - Phone:936-554-6995
Mailing Address - Fax:
Practice Address - Street 1:1204 W FRANK AVE
Practice Address - Street 2:
Practice Address - City:LUFKIN
Practice Address - State:TX
Practice Address - Zip Code:75904-3304
Practice Address - Country:US
Practice Address - Phone:936-634-8111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-12
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1149603367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered