Provider Demographics
NPI:1952761264
Name:WATT, SARAH GENE (PA)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:GENE
Last Name:WATT
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:528 4TH AVE N
Mailing Address - Street 2:
Mailing Address - City:GREYBULL
Mailing Address - State:WY
Mailing Address - Zip Code:82426-1928
Mailing Address - Country:US
Mailing Address - Phone:307-751-4201
Mailing Address - Fax:
Practice Address - Street 1:388 US HIGHWAY 20 S
Practice Address - Street 2:
Practice Address - City:BASIN
Practice Address - State:WY
Practice Address - Zip Code:82410-8902
Practice Address - Country:US
Practice Address - Phone:307-568-3311
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-29
Last Update Date:2016-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYPT672363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant