Provider Demographics
NPI:1982820080
Name:JOHNSON, SARAH KELLI (PA)
Entity type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:KELLI
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:PA
Other - Prefix:MISS
Other - First Name:SARAH
Other - Middle Name:KELLI
Other - Last Name:BRADSHAW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:PO BOX 1869
Mailing Address - Street 2:
Mailing Address - City:FLETCHER
Mailing Address - State:NC
Mailing Address - Zip Code:28732-1869
Mailing Address - Country:US
Mailing Address - Phone:828-687-5616
Mailing Address - Fax:828-650-8076
Practice Address - Street 1:50 HOSPITAL DR
Practice Address - Street 2:SUITE 2A
Practice Address - City:HENDERSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28792-5248
Practice Address - Country:US
Practice Address - Phone:828-654-6015
Practice Address - Fax:828-687-6058
Is Sole Proprietor?:No
Enumeration Date:2007-04-17
Last Update Date:2016-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC103965363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC103965OtherLICENSE
NC162EAOtherBCBS OF NC
NCP01248091OtherMEDICARE RR
NCP01248091OtherMEDICARE RR