Provider Demographics
NPI:1023589744
Name:MIKELL, SARAH SIMMONS (FNP-C)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:SIMMONS
Last Name:MIKELL
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 W MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:ALAMO
Mailing Address - State:GA
Mailing Address - Zip Code:30411
Mailing Address - Country:US
Mailing Address - Phone:912-568-1438
Mailing Address - Fax:912-568-7313
Practice Address - Street 1:9 W MAIN STREET
Practice Address - Street 2:
Practice Address - City:ALAMO
Practice Address - State:GA
Practice Address - Zip Code:30411
Practice Address - Country:US
Practice Address - Phone:912-568-1438
Practice Address - Fax:912-568-7313
Is Sole Proprietor?:No
Enumeration Date:2018-12-06
Last Update Date:2023-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN254463363LF0000X
GANCO-000001363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily