Provider Demographics
NPI:1023191392
Name:SARGENT, MARIA BAKER (ARNP)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:BAKER
Last Name:SARGENT
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 550
Mailing Address - Street 2:
Mailing Address - City:VANCEBURG
Mailing Address - State:KY
Mailing Address - Zip Code:41179-0550
Mailing Address - Country:US
Mailing Address - Phone:606-956-0162
Mailing Address - Fax:
Practice Address - Street 1:100 BELLEFONTE DR
Practice Address - Street 2:
Practice Address - City:GRAYSON
Practice Address - State:KY
Practice Address - Zip Code:41143-1820
Practice Address - Country:US
Practice Address - Phone:606-474-0669
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2021-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN09464363LF0000X
KY4971P363LF0000X
KY3004971363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2705068Medicaid
KYP00754286OtherRR MEDICARE
KY000000556884OtherANTHEM BCBS
KY000000609843OtherANTHEM BCBS
KY7100000990Medicaid
KYP00602511OtherRR MEDICARE
KY0643024Medicare PIN
KY7100000990Medicaid
KYP00602511OtherRR MEDICARE
KY0641237Medicare PIN