Provider Demographics
NPI:1861689606
Name:WELCH, SARA E (PA-C)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:E
Last Name:WELCH
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 1:7101 US HIGHWAY 90 STE 102
Mailing Address - Street 2:
Mailing Address - City:DAPHNE
Mailing Address - State:AL
Mailing Address - Zip Code:36526-9510
Mailing Address - Country:US
Mailing Address - Phone:251-278-6022
Mailing Address - Fax:251-278-3930
Practice Address - Street 1:7101 US HIGHWAY 90 STE 102
Practice Address - Street 2:
Practice Address - City:DAPHNE
Practice Address - State:AL
Practice Address - Zip Code:36526-9510
Practice Address - Country:US
Practice Address - Phone:251-278-6022
Practice Address - Fax:251-278-3930
Is Sole Proprietor?:No
Enumeration Date:2007-09-25
Last Update Date:2022-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPA 650363AM0700X
ALPA.650363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL511-66478OtherBC OF AL PROVIDER NUMBER
AL101I974965Medicare UPIN