Provider Demographics
NPI:1942232160
Name:BONE, SARAH L (PA-C, ATC)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:L
Last Name:BONE
Suffix:
Gender:F
Credentials:PA-C, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2165 MEDICAL PARK DR
Mailing Address - Street 2:
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28602-8809
Mailing Address - Country:US
Mailing Address - Phone:828-324-2800
Mailing Address - Fax:828-294-9141
Practice Address - Street 1:2165 MEDICAL PARK DR
Practice Address - Street 2:
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28602-8809
Practice Address - Country:US
Practice Address - Phone:828-324-2800
Practice Address - Fax:828-294-9141
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2016-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601004436363A00000X
NC0010-06656363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2058216240OtherBCBS PROVIDER PIN
MI300027028OtherDR SORCE TAX ID
MI2058216240OtherBCBS PROVIDER PIN