SARA DEATHERAGE (NPI# 1104374693) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1104374693 |
| Entity Type | Individual |
| Full Name | SARA DEATHERAGE |
| Credential | FNP-C |
| Practice Address |
940 General Booth Blvd Virginia Beach VA 23451-4861 |
| Mailing Address |
1601 Barton Rd 109 Redlands CA 92373 |
| Practice Telephone | 7574253610 |
| Mailing Telephone | 7608924107 |
| Enumeration Date | 2016-09-14 |
| Last Update Date | 2019-07-18 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 163W00000X | Registered Nurse | 819106 | CA | Nursing Service Providers |
| Y | 363LF0000X |
Nurse Practitioner Specialization: Family |
0024177684 | VA | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
940 GENERAL BOOTH BLVD |
| City | VIRGINIA BEACH |
| State | VA |
| Zip Code | 23451-4861 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1306814173 | Pauline Carvella Reed | Family Medicine | 940 General Booth Blvd, Suite A, Virginia Beach, VA 23451-4857 | 2006-03-09 |
| 1396117180 | Kaylie Elizabeth Wren | Physician Assistant | 940 General Booth Blvd, Virginia Beach, VA 23451-4861 | 2015-10-20 |
| 1417385931 | Holley Family Dentistry of Virginia Beach | Dentist | 940 General Booth Blvd, Suite C, Virginia Beach, VA 23451 | 2013-10-18 |
| 1851723894 | Tiffany M Griffin | Physician Assistant | 940 General Booth Blvd, Suite A, Virginia Beach, VA 23451-4861 | 2013-08-01 |
| 1053545681 | Lauren Nicole Gillis | Nurse Practitioner | 940 General Booth Blvd, Virginia Beach, VA 23451-4857 | 2009-05-11 |
| 1902050875 | Peninsula Institute for Community Health Inc | Clinic/Center | 940 General Booth Blvd, Suite A, Virginia Beach, VA 23451-4857 | 2008-11-05 |
| 1598808883 | Carter L Richards | Dentist | 940 General Booth Blvd, Suite #c, Virginia Beach, VA 23451-4857 | 2007-02-15 |
| 1922117142 | Andrei San-marina | Internal Medicine | 940 General Booth Blvd, Virginia Beach, VA 23451-4861 | 2006-08-30 |
| 1982633640 | Donald L Cochran | Family Medicine | 940 General Booth Blvd, Virginia Beach, VA 23451-4861 | 2006-07-02 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1316547268 | Brynn Arica Carey | Speech-Language Pathologist | Laskin Road Annex, 1413 Laskin Road, Virginia Beach, VA 23451 | 2020-10-29 |
| 1851864094 | Erica Genevieve Johns | Counselor | 253 C Street, Camp Pendleton, Virginia Beach, VA 23451 | 2019-01-10 |
| 1407327729 | Crystal Michelle Larios | Physical Therapy Assistant | Westminster Canterbury, Virginia Beach, VA 23451 | 2018-12-14 |
| 1215423322 | Ketan Patel | Dentist | 395 Norfolk Ave, Virginia Beach, VA 23451 | 2018-07-02 |
| 1356844427 | Kristina Maria Matthews | Nurse's Aide | 1206 Laskin Road, Suite 140-g, Virginia Beach, VA 23451 | 2018-03-14 |
| 1437652823 | Beach Medical Suppliers LLC | Durable Medical Equipment & Medical Supplies | 2256 W. Great Neck Rd, Virginia Beach, VA 23451 | 2018-03-13 |
| 1740782291 | Sherree Weeks | Speech-Language Pathologist | 1413 Laskin Rd., Va. Beach, VA 23451 | 2018-03-01 |
| 1649709007 | Christine Herslow | Registered Nurse | 2200 Elder Road, Virginia Beach, VA 23451 | 2017-06-08 |
| 1538611066 | Wal-mart Stores East, Lp | Technician/Technologist | 546 First Colonial Road, Virginia Beach, VA 23451 | 2016-11-01 |
| 1306182795 | John Leroy Stacy Jr. | Counselor | 409 Birdneck Cir, Virginia Beach, VA 23451 | 2012-12-12 |
| Find all providers in zip 23451 | ||||
| Taxonomy Code | 363LF0000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Family |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1881294783 | Amy K Volk | Nurse Practitioner | 272 Bendix Rd Ste 100, Virginia Beach, VA 23452-1380 | 2020-10-29 |
| 1407462575 | Jody Lynn Glass | Nurse Practitioner | 1567 Back Bay Landing Rd, Virginia Beach, VA 23457-1338 | 2020-09-23 |
| 1063027373 | Karen Elaine Callaway | Nurse Practitioner | 937 Sunnyside Dr, Virginia Beach, VA 23464-2128 | 2020-09-14 |
| 1477177582 | Laura Michelle Rossin | Nurse Practitioner | 736 Sequoia Way, Virginia Beach, VA 23451-4471 | 2020-06-04 |
| 1356964373 | A New Day Healthcare | Nurse Practitioner | 1604 Hilltop West Ctr Ste 215, Virginia Beach, VA 23451-6196 | 2020-05-26 |
| 1710508049 | Christina Barnett | Nurse Practitioner | 1413 Dermott Ave, Virginia Beach, VA 23455-4119 | 2020-04-28 |
| 1336769934 | Leah Rose | Nurse Practitioner | 4477 Pissarro Dr, Virginia Beach, VA 23456-5468 | 2020-04-23 |
| 1174151310 | Angela Fleetwood | Nurse Practitioner | 5712 Bannock Rd, Virginia Beach, VA 23462-3904 | 2020-04-01 |
| 1508498676 | John Charles Rowe Jr. | Nurse Practitioner | 4812 Station House Ln, Virginia Beach, VA 23455-1935 | 2020-02-06 |
| 1356997613 | Alfreda Curtis | Nurse Practitioner | 1527 Brendle Ct, Virginia Beach, VA 23464-6761 | 2019-08-13 |
| Find all providers in VIRGINIA BEACH | ||||
| City | VIRGINIA BEACH |
| Zip Code | 23451 |
Please comment or provide details below to improve the information on SARA DEATHERAGE.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.