Provider Demographics
NPI:1689924961
Name:BISHOP, SARA LYNNE (PA-C)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:LYNNE
Last Name:BISHOP
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3714 GUARDIAN AVE STE E
Mailing Address - Street 2:
Mailing Address - City:MOREHEAD CITY
Mailing Address - State:NC
Mailing Address - Zip Code:28557-2975
Mailing Address - Country:US
Mailing Address - Phone:252-247-2101
Mailing Address - Fax:252-247-4675
Practice Address - Street 1:1200 HARGETT ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28540-5933
Practice Address - Country:US
Practice Address - Phone:910-219-1082
Practice Address - Fax:910-219-1087
Is Sole Proprietor?:No
Enumeration Date:2012-09-14
Last Update Date:2022-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1689924961Medicaid
NCNCA917B643Medicare PIN