Healthcare Provider Details

I. General information

NPI: 1699500314
Provider Name (Legal Business Name): SARA SANDERS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2024
Last Update Date: 10/22/2024
Certification Date: 10/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

279 KINGS DAUGHTERS DR STE 301
FRANKFORT KY
40601-6564
US

IV. Provider business mailing address

PO BOX 1080
BURKESVILLE KY
42717-1080
US

V. Phone/Fax

Practice location:
  • Phone: 502-227-2229
  • Fax: 502-227-1114
Mailing address:
  • Phone: 270-858-6655
  • Fax: 270-858-4027

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number4023922
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: