Provider Demographics
NPI:1215168075
Name:DICKEY, SARA A (FNP-BC)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:A
Last Name:DICKEY
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 FOUNDATION WAY
Mailing Address - Street 2:
Mailing Address - City:MARTINSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:25401-9000
Mailing Address - Country:US
Mailing Address - Phone:304-264-9202
Mailing Address - Fax:304-264-9042
Practice Address - Street 1:171 TAYLOR ST
Practice Address - Street 2:
Practice Address - City:HARPERS FERRY
Practice Address - State:WV
Practice Address - Zip Code:25425-3641
Practice Address - Country:US
Practice Address - Phone:304-535-6343
Practice Address - Fax:304-535-6618
Is Sole Proprietor?:No
Enumeration Date:2009-07-28
Last Update Date:2015-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR186432363LF0000X
NYF33549-1363LF0000X
WV72634363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810024999Medicaid
WVWV2462AMedicare PIN