Provider Demographics
NPI:1790930832
Name:SNITKER, SARAH KAE (PA)
Entity Type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:KAE
Last Name:SNITKER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:KAE
Other - Last Name:CHRISTIANSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12222 COIT RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75251-2302
Mailing Address - Country:US
Mailing Address - Phone:972-726-6647
Mailing Address - Fax:972-726-6797
Practice Address - Street 1:12222 COIT RD
Practice Address - Street 2:SUITE 102
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75251-2302
Practice Address - Country:US
Practice Address - Phone:972-726-6647
Practice Address - Fax:972-726-6797
Is Sole Proprietor?:No
Enumeration Date:2008-11-17
Last Update Date:2010-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2008033560363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2086SO122XMedicaid