Provider Demographics
NPI:1154446854
Name:STALL, SARAH (PA-C)
Entity type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:
Last Name:STALL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:SARAH
Other - Middle Name:
Other - Last Name:GAINEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:901 DENIM DR
Mailing Address - Street 2:
Mailing Address - City:ERWIN
Mailing Address - State:NC
Mailing Address - Zip Code:28339-2307
Mailing Address - Country:US
Mailing Address - Phone:910-897-2003
Mailing Address - Fax:910-897-5587
Practice Address - Street 1:901 DENIM DR
Practice Address - Street 2:
Practice Address - City:ERWIN
Practice Address - State:NC
Practice Address - Zip Code:28339-2307
Practice Address - Country:US
Practice Address - Phone:910-897-2003
Practice Address - Fax:910-897-5587
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2020-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC001000801363AM0700X
NC0010-00801363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCNCH344AMedicare PIN