Provider Demographics
NPI:1831299940
Name:SORRELL, SARA L (PA)
Entity Type:Individual
Prefix:MS
First Name:SARA
Middle Name:L
Last Name:SORRELL
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:613 23RD STREET
Mailing Address - Street 2:SUITE 440
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41101
Mailing Address - Country:US
Mailing Address - Phone:606-329-2888
Mailing Address - Fax:606-329-2890
Practice Address - Street 1:613 23RD STREET
Practice Address - Street 2:SUITE 440
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41101
Practice Address - Country:US
Practice Address - Phone:606-329-2888
Practice Address - Fax:606-329-2890
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2009-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPA638363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY95001806Medicaid
KYPA638Medicare UPIN
KY0684902Medicare ID - Type Unspecified