Provider Demographics
NPI:1306076336
Name:DEDRICK, SARAH E (CPNP)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:E
Last Name:DEDRICK
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:E
Other - Last Name:SIEBENMORGAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1425 NW BLUE PKWY
Mailing Address - Street 2:
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64086-5705
Mailing Address - Country:US
Mailing Address - Phone:816-524-3223
Mailing Address - Fax:816-525-2697
Practice Address - Street 1:1425 NW BLUE PKWY
Practice Address - Street 2:
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64086-5705
Practice Address - Country:US
Practice Address - Phone:816-524-3223
Practice Address - Fax:816-525-2697
Is Sole Proprietor?:No
Enumeration Date:2009-07-24
Last Update Date:2025-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO154611363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO363LP0200XMedicaid