Healthcare Provider Details

I. General information

NPI: 1427009711
Provider Name (Legal Business Name): SIBYL C CAGATA ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 11/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3991 DUTCHMANS LN SUITE 405
LOUISVILLE KY
40207-4700
US

IV. Provider business mailing address

PO BOX 776347
CHICAGO IL
60677-6347
US

V. Phone/Fax

Practice location:
  • Phone: 502-899-3366
  • Fax: 502-899-3455
Mailing address:
  • Phone: 502-899-3366
  • Fax: 502-899-3455

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number3050P
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: