Provider Demographics
NPI:1134861404
Name:SKILLMAN, SARA LYNN (CPNP)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:LYNN
Last Name:SKILLMAN
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 602195
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-2195
Mailing Address - Country:US
Mailing Address - Phone:919-350-8991
Mailing Address - Fax:919-350-7687
Practice Address - Street 1:204 MEDSPRING DR
Practice Address - Street 2:
Practice Address - City:CLAYTON
Practice Address - State:NC
Practice Address - Zip Code:27520-9293
Practice Address - Country:US
Practice Address - Phone:919-235-6505
Practice Address - Fax:919-235-6536
Is Sole Proprietor?:No
Enumeration Date:2022-04-08
Last Update Date:2023-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC202018089363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0Medicaid