Healthcare Provider Details

I. General information

NPI: 1760654032
Provider Name (Legal Business Name): SARA E HARRIS C.AC.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2008
Last Update Date: 03/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

296 SOUTHLAND DR
LEXINGTON KY
40503-1932
US

IV. Provider business mailing address

301 CHIPPEN DALE CIRCLE
LEXINGTON KY
40517-4405
US

V. Phone/Fax

Practice location:
  • Phone: 859-402-2430
  • Fax:
Mailing address:
  • Phone: 859-309-1743
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC040
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: