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General NPI Number Information
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NPI Number | 1083154801
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Entity Type | Individual
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Provider Name | KAYLA SARGENT
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Gender | Female
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Dates
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Enumeration Date | 02/27/2017
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Last Update Date | 12/01/2022
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Provider Practice Location Address
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Address Line | 3651 HIGHWAY 2565 2ND FLOOR
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City | LOUISA
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State | KY
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Zip | 41230-5018
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Country | US
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Telephone | 606-254-8959
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Fax |
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Provider Business Mailing Address
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Address Line | 716 SCHOOL RD
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City | CUMBERLAND
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State | KY
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Zip | 40823-1117
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Country | US
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Telephone | 606-263-1549
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 175T00000X
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Taxonomy Name | Peer Specialist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | CDCA.182731
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License Number State | OH
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