Provider Demographics
NPI:1841077088
Name:PELLERIN, SARAH KATHRYN
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:KATHRYN
Last Name:PELLERIN
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 1:25202 BAYWICK DR
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77389-3324
Mailing Address - Country:US
Mailing Address - Phone:337-351-9415
Mailing Address - Fax:
Practice Address - Street 1:1111 MEDICAL PLAZA DR STE 250
Practice Address - Street 2:
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77380-3477
Practice Address - Country:US
Practice Address - Phone:281-296-8788
Practice Address - Fax:281-465-4569
Is Sole Proprietor?:No
Enumeration Date:2023-09-12
Last Update Date:2025-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA17303363A00000X
363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant