Provider Demographics
NPI:1861519225
Name:KLOPP, SARA NICOLE (PA-C)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:NICOLE
Last Name:KLOPP
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 1:900 E 30TH ST
Mailing Address - Street 2:#205
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78705-3326
Mailing Address - Country:US
Mailing Address - Phone:512-477-1405
Mailing Address - Fax:512-477-1220
Practice Address - Street 1:900 E 30TH ST
Practice Address - Street 2:#205
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78705-3326
Practice Address - Country:US
Practice Address - Phone:512-477-1405
Practice Address - Fax:512-477-1220
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-23
Last Update Date:2013-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA03993363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant