Provider Demographics
NPI:1053112250
Name:CARROLL, SARA NICOLE (DO)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:NICOLE
Last Name:CARROLL
Suffix:
Gender:
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14405 NW 74TH ST
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64152-5121
Mailing Address - Country:US
Mailing Address - Phone:816-377-1577
Mailing Address - Fax:
Practice Address - Street 1:14405 NW 74TH ST
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64152-5121
Practice Address - Country:US
Practice Address - Phone:816-377-1577
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-24
Last Update Date:2025-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program