Provider Demographics
NPI:1386115897
Name:ANDERSON, SARAH KATHRYN (PA-C)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:KATHRYN
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 NE SAINT LUKES BLVD STE 350
Mailing Address - Street 2:
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64086-6007
Mailing Address - Country:US
Mailing Address - Phone:816-347-4717
Mailing Address - Fax:816-347-7466
Practice Address - Street 1:20 NE SAINT LUKES BLVD STE 350
Practice Address - Street 2:
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64086-6007
Practice Address - Country:US
Practice Address - Phone:816-347-4717
Practice Address - Fax:816-347-7466
Is Sole Proprietor?:No
Enumeration Date:2018-12-09
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
ORPA209297363A00000X
MS2019039571363AM0700X
MO2019039571363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500802515Medicaid