Provider Demographics
NPI:1023485372
Name:MCKEOWN, SARAH REBECCA (PA-C)
Entity type:Individual
Prefix:MS
First Name:SARAH
Middle Name:REBECCA
Last Name:MCKEOWN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:537 MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18510-2422
Mailing Address - Country:US
Mailing Address - Phone:607-651-6554
Mailing Address - Fax:
Practice Address - Street 1:221 RIVER ST
Practice Address - Street 2:
Practice Address - City:OLYPHANT
Practice Address - State:PA
Practice Address - Zip Code:18447-1475
Practice Address - Country:US
Practice Address - Phone:570-383-3636
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-21
Last Update Date:2017-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA207Q00000X207Q00000X
PAOA003630363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine