Provider Demographics
NPI:1831087592
Name:WORTHINGTON, SARA RACHEL
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:RACHEL
Last Name:WORTHINGTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:275 LAKEPOINT PL N APT 132
Mailing Address - Street 2:
Mailing Address - City:KEIZER
Mailing Address - State:OR
Mailing Address - Zip Code:97303-3684
Mailing Address - Country:US
Mailing Address - Phone:503-735-5797
Mailing Address - Fax:
Practice Address - Street 1:275 LAKEPOINT PL N APT 132
Practice Address - Street 2:
Practice Address - City:KEIZER
Practice Address - State:OR
Practice Address - Zip Code:97303-3684
Practice Address - Country:US
Practice Address - Phone:503-735-5797
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-24
Last Update Date:2025-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR10046068363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health