Provider Demographics
NPI:1720184278
Name:YOUNGBLOOD, SARAH B (PA)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:B
Last Name:YOUNGBLOOD
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:W
Other - Last Name:BASINGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 4330
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:CO
Mailing Address - Zip Code:81620-4330
Mailing Address - Country:US
Mailing Address - Phone:970-926-6340
Mailing Address - Fax:970-926-6348
Practice Address - Street 1:322 BEARD CREEK ROAD
Practice Address - Street 2:SUITE 1300
Practice Address - City:EDWARDS
Practice Address - State:CO
Practice Address - Zip Code:81632-5068
Practice Address - Country:US
Practice Address - Phone:970-926-9226
Practice Address - Fax:970-926-8755
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2021-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1876363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1876OtherCOLORADO STATE LICENSE