Provider Demographics
NPI:1922654656
Name:KOETTER, SARAH LEIGH
Entity Type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:LEIGH
Last Name:KOETTER
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 1:1432 HOFF RD
Mailing Address - Street 2:
Mailing Address - City:WINDTHORST
Mailing Address - State:TX
Mailing Address - Zip Code:76389-3100
Mailing Address - Country:US
Mailing Address - Phone:940-237-2820
Mailing Address - Fax:
Practice Address - Street 1:1600 11TH ST
Practice Address - Street 2:
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76301-4300
Practice Address - Country:US
Practice Address - Phone:940-764-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-19
Last Update Date:2019-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP141016363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care