MEDICARE: SARAH RUTH PEYTON FNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	3009092	KY

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	K187301	OTHER	KY	MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1033507561
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARAH RUTH PEYTON FNP

Provider Business Mailing Address
First Line	:	PO BOX 950248
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40295-0248
Country	:	US
Telephone Number	:	502-253-4900
Fax Number	:	502-489-5750

Provider Business Practice Location Address
First Line	:	1851 N MAIN ST
Second Line	:
City	:	MADISONVILLE
State	:	KY
Zip	:	42431-9024
Country	:	US
Telephone Number	:	270-825-7268
Fax Number	:	270-825-6615

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/06/2015
Last Update Date	:	03/17/2018

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