Provider Demographics
NPI:1134744410
Name:HALE, SARA ELIZABETH
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:ELIZABETH
Last Name:HALE
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 1:323 E HAWKINS PKWY
Mailing Address - Street 2:STE A
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75605-8162
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:323 E HAWKINS PKWY
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75605-8153
Practice Address - Country:US
Practice Address - Phone:903-758-2746
Practice Address - Fax:903-758-7127
Is Sole Proprietor?:No
Enumeration Date:2020-06-11
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1005541363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX413368801Medicaid