Provider Demographics
NPI:1912370545
Name:WILSON, SARAH H (PA-C)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:H
Last Name:WILSON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:800 ROSE ST
Mailing Address - Street 2:MN602
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40536-0294
Mailing Address - Country:US
Mailing Address - Phone:859-323-6047
Mailing Address - Fax:859-257-3873
Practice Address - Street 1:4421 EASTGATE BLVD STE 300
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45245-4501
Practice Address - Country:US
Practice Address - Phone:513-752-8000
Practice Address - Fax:513-752-1078
Is Sole Proprietor?:No
Enumeration Date:2015-11-04
Last Update Date:2018-01-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH50005372RX363AM0700X
KYTC441363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical