Provider Demographics
NPI:1841611357
Name:CROOK, SARAH SHEA (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:SHEA
Last Name:CROOK
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1021 W OAKLAND AVE STE 310
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37604-2192
Mailing Address - Country:US
Mailing Address - Phone:423-302-6565
Mailing Address - Fax:
Practice Address - Street 1:405 SCENIC DR STE A
Practice Address - Street 2:
Practice Address - City:ROGERSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37857-2441
Practice Address - Country:US
Practice Address - Phone:423-921-3490
Practice Address - Fax:423-272-7667
Is Sole Proprietor?:No
Enumeration Date:2013-12-31
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110005045363AM0700X
TN2467363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAVVJ090B288Medicare PIN
TN103I970841Medicare PIN