Healthcare Provider Details

I. General information

NPI: 1790776102
Provider Name (Legal Business Name): SARA BETH SEIFERT PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SARA B ROBINSON PA-C

II. Dates (important events)

Enumeration Date: 11/03/2005
Last Update Date: 10/27/2020
Certification Date: 10/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3900 KRESGE WAY SUITE 51
LOUISVILLE KY
40207-4660
US

IV. Provider business mailing address

PO BOX 950248
LOUISVILLE KY
40295-0248
US

V. Phone/Fax

Practice location:
  • Phone: 502-259-5955
  • Fax: 502-259-5953
Mailing address:
  • Phone: 502-489-5730
  • Fax: 502-489-5753

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA846
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: