Provider Demographics
NPI:1073975983
Name:MARTIN, SARA JANE (APRN)
Entity Type:Individual
Prefix:MRS
First Name:SARA
Middle Name:JANE
Last Name:MARTIN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:MS
Other - First Name:SARA
Other - Middle Name:
Other - Last Name:WESTMORELAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:3604 WATHENS XING
Mailing Address - Street 2:
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42301-7035
Mailing Address - Country:US
Mailing Address - Phone:270-684-6144
Mailing Address - Fax:270-684-2944
Practice Address - Street 1:3604 WATHENS XING
Practice Address - Street 2:
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42301
Practice Address - Country:US
Practice Address - Phone:270-684-6144
Practice Address - Fax:270-684-2944
Is Sole Proprietor?:No
Enumeration Date:2016-03-22
Last Update Date:2021-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3010205363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100428070Medicaid
KY3010205OtherSTATE LICENSE
000001009856OtherANTHEM BC/BS