Healthcare Provider Details

I. General information

NPI: 1033507561
Provider Name (Legal Business Name): SARAH RUTH PEYTON FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/06/2015
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1851 N MAIN ST
MADISONVILLE KY
42431-9024
US

IV. Provider business mailing address

PO BOX 950248
LOUISVILLE KY
40295-0248
US

V. Phone/Fax

Practice location:
  • Phone: 270-825-7268
  • Fax: 270-825-6615
Mailing address:
  • Phone: 502-253-4900
  • Fax: 502-489-5750

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3009092
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: