Healthcare Provider Details

I. General information

NPI: 1942955737
Provider Name (Legal Business Name): SUBLIME SKIN, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2022
Last Update Date: 03/22/2024
Certification Date: 03/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3221 FREDERICA ST STE A&B
OWENSBORO KY
42301-6086
US

IV. Provider business mailing address

3221 FREDERICA ST STE A&B
OWENSBORO KY
42301-6086
US

V. Phone/Fax

Practice location:
  • Phone: 270-297-7546
  • Fax: 270-215-7757
Mailing address:
  • Phone: 270-297-7546
  • Fax: 270-215-7757

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code364S00000X
TaxonomyClinical Nurse Specialist
License Number
License Number State

VIII. Authorized Official

Name: DR. SARA LYNN DOOLIN THOMPSON
Title or Position: OWNER, HEALTH CARE PROVIDER
Credential: DNP, APRN-BC, CNOR
Phone: 270-297-7546