Provider Demographics
NPI:1417789975
Name:EDGE, SARAH MICAYLA HENDERSON (APRN-FNP)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:MICAYLA HENDERSON
Last Name:EDGE
Suffix:
Gender:F
Credentials:APRN-FNP
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:MICAYLA
Other - Last Name:HENDERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1440 MAJESTIC DR
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89503-3538
Mailing Address - Country:US
Mailing Address - Phone:775-742-7558
Mailing Address - Fax:
Practice Address - Street 1:880 RYLAND ST
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-1603
Practice Address - Country:US
Practice Address - Phone:775-329-4600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-14
Last Update Date:2024-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV880160363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily