Provider Demographics
NPI:1033159223
Name:SANDLIN, DONNA S (APRN)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:S
Last Name:SANDLIN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 BENTLEY RD
Mailing Address - Street 2:
Mailing Address - City:LONDON
Mailing Address - State:KY
Mailing Address - Zip Code:40744-8849
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:210 MARIE LANGDON DR
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:KY
Practice Address - Zip Code:40962-6195
Practice Address - Country:US
Practice Address - Phone:606-598-5104
Practice Address - Fax:606-598-0983
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2018-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1083411363L00000X
KY3791P363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000586717OtherBLUE CROSS & BLUE SHIELD
KY78008273Medicaid
KY000000514608OtherBLUE CROSS BLUE SHEILD
KY7100014610OtherMEDICAID NP GROUP NUMBER
KYP00409709OtherRAILROAD MEDICARE
KY000000514608OtherBLUE CROSS BLUE SHEILD
KY0608116Medicare PIN
KY000000586717OtherBLUE CROSS & BLUE SHIELD