Individual
SARAH SOUTHARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
102 HIGHLAND AVE SE, ROANOKE, VA 24013-2254
(540) 985-9835
Mailing address
118 PAR DR, SALEM, VA 24153-6811
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
0001-078793
VA
363LP0200X
Pediatric Nurse Practitioner
Primary
0024078793
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
007781105
—
VA
Enumeration date
02/02/2006
Last updated
05/12/2008
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