Provider Demographics
NPI:1891808275
Name:MORELAND, SARA HOLLY (MSN)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:HOLLY
Last Name:MORELAND
Suffix:
Gender:F
Credentials:MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 N HIGHWAY 77
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WAXAHACHIE
Mailing Address - State:TX
Mailing Address - Zip Code:75165-1128
Mailing Address - Country:US
Mailing Address - Phone:972-923-1686
Mailing Address - Fax:972-923-9268
Practice Address - Street 1:505 N HIGHWAY 77
Practice Address - Street 2:SUITE 200
Practice Address - City:WAXAHACHIE
Practice Address - State:TX
Practice Address - Zip Code:75165-1128
Practice Address - Country:US
Practice Address - Phone:972-923-1686
Practice Address - Fax:972-923-9268
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2022-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX651741363L00000X, 363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX184808702Medicaid
TX8L5669Medicare PIN
TX8J3734Medicare PIN
TXQ75906Medicare UPIN