Provider Demographics
NPI:1932699972
Name:MEDSKER, SARA
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:MEDSKER
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 1:2200 E PARRISH AVE STE 101B
Mailing Address - Street 2:
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42303-1450
Mailing Address - Country:US
Mailing Address - Phone:270-683-3232
Mailing Address - Fax:270-852-1600
Practice Address - Street 1:2200 E PARRISH AVE STE 101B
Practice Address - Street 2:
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42303-1450
Practice Address - Country:US
Practice Address - Phone:270-683-3232
Practice Address - Fax:270-852-1600
Is Sole Proprietor?:No
Enumeration Date:2018-05-15
Last Update Date:2021-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY04915208000000X
TXBP10063427208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics