Provider Demographics
NPI:1053074104
Name:GADDY, SARAH NICOLE (LVN)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:NICOLE
Last Name:GADDY
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:295 COUNTY ROAD 14690
Mailing Address - Street 2:
Mailing Address - City:PARIS
Mailing Address - State:TX
Mailing Address - Zip Code:75462-3918
Mailing Address - Country:US
Mailing Address - Phone:903-905-9611
Mailing Address - Fax:
Practice Address - Street 1:295 COUNTY ROAD 14690
Practice Address - Street 2:
Practice Address - City:PARIS
Practice Address - State:TX
Practice Address - Zip Code:75462-3918
Practice Address - Country:US
Practice Address - Phone:903-905-9611
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-15
Last Update Date:2021-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX332420164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse