Provider Demographics
NPI:1740754886
Name:WATTS, SARAH OPAL LYNN (PA)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:OPAL LYNN
Last Name:WATTS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:OPAL LYNN
Other - Last Name:ARTHUR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:PO BOX 802843
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64180-2843
Mailing Address - Country:US
Mailing Address - Phone:417-730-6430
Mailing Address - Fax:417-269-7567
Practice Address - Street 1:121 CAHILL RD STE 206
Practice Address - Street 2:
Practice Address - City:BRANSON
Practice Address - State:MO
Practice Address - Zip Code:65616-1911
Practice Address - Country:US
Practice Address - Phone:417-348-8100
Practice Address - Fax:417-348-8104
Is Sole Proprietor?:No
Enumeration Date:2019-01-11
Last Update Date:2022-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2019002627363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant