Healthcare Provider Details

I. General information

NPI: 1497088058
Provider Name (Legal Business Name): SIBBY S DUFF APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SIBBY SUEZETTE SERRENO

II. Dates (important events)

Enumeration Date: 09/15/2009
Last Update Date: 05/04/2020
Certification Date: 05/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 ROSE ST
LEXINGTON KY
40536-0001
US

IV. Provider business mailing address

800 ROSE ST
LEXINGTON KY
40536-0001
US

V. Phone/Fax

Practice location:
  • Phone: 859-323-0100
  • Fax: 859-323-0100
Mailing address:
  • Phone: 859-323-0100
  • Fax: 859-323-0100

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License Number6034P
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: