Provider Demographics
NPI:1942596614
Name:KING, SARAH M (CNP)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:M
Last Name:KING
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7756 WASHINGTON VILLAGE DR
Mailing Address - Street 2:SUITE 135
Mailing Address - City:CENTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45459-3999
Mailing Address - Country:US
Mailing Address - Phone:937-531-0190
Mailing Address - Fax:937-531-0191
Practice Address - Street 1:7756 WASHINGTON VILLAGE DR
Practice Address - Street 2:SUITE 135
Practice Address - City:CENTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:45459-3999
Practice Address - Country:US
Practice Address - Phone:937-531-0190
Practice Address - Fax:937-531-0191
Is Sole Proprietor?:No
Enumeration Date:2011-06-21
Last Update Date:2022-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNP12378363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0051152Medicaid
OHH022891Medicare PIN