Healthcare Provider Details

I. General information

NPI: 1568926384
Provider Name (Legal Business Name): SARAH CATHERINE KELLER BRAY APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/25/2019
Last Update Date: 05/01/2025
Certification Date: 04/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4123 DUTCHMANS LN STE 606
LOUISVILLE KY
40207-4725
US

IV. Provider business mailing address

PO BOX 776879
CHICAGO IL
60677-6351
US

V. Phone/Fax

Practice location:
  • Phone: 502-896-2500
  • Fax: 502-896-2527
Mailing address:
  • Phone: 502-558-7704
  • Fax: 502-272-5116

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3012652
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number3012652
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: