Provider Demographics
NPI:1134583701
Name:BAGLEY, SARAH KATHRYN (PA-C)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:KATHRYN
Last Name:BAGLEY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:KATHRYN
Other - Last Name:DRISCOLL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:704-316-3410
Mailing Address - Fax:704-316-3420
Practice Address - Street 1:10905 PROVIDENCE RD W
Practice Address - Street 2:STE 270
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277-1538
Practice Address - Country:US
Practice Address - Phone:704-316-3410
Practice Address - Fax:704-316-3420
Is Sole Proprietor?:No
Enumeration Date:2016-04-11
Last Update Date:2024-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-13260363A00000X
363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant