Healthcare Provider Details

I. General information

NPI: 1578687802
Provider Name (Legal Business Name): CHARLOTTE SERGENT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2007
Last Update Date: 02/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2201 LEXINGTON AVE
ASHLAND KY
41101-2843
US

IV. Provider business mailing address

2201 LEXINGTON AVE
ASHLAND KY
41101-2843
US

V. Phone/Fax

Practice location:
  • Phone: 606-408-4457
  • Fax: 606-408-7425
Mailing address:
  • Phone: 606-408-4457
  • Fax: 606-408-7425

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number0129
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: