Provider Demographics
NPI:1245204593
Name:MCNALLY, SARA L (CRNA)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:L
Last Name:MCNALLY
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9050 BARBOURVILLE RD
Mailing Address - Street 2:
Mailing Address - City:LONDON
Mailing Address - State:KY
Mailing Address - Zip Code:40744-9327
Mailing Address - Country:US
Mailing Address - Phone:606-878-1860
Mailing Address - Fax:
Practice Address - Street 1:500 N NAPPANEE ST
Practice Address - Street 2:STE 11-B
Practice Address - City:ELKHART
Practice Address - State:IN
Practice Address - Zip Code:46514-1503
Practice Address - Country:US
Practice Address - Phone:574-522-9922
Practice Address - Fax:574-522-9926
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2012-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2667A367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000380611OtherANTHEM PROVIDER #
KY61-1427889OtherBLUEGRASS FAMILY HEALTH
KYC20863OtherCUMBERLAND HEALTHCARE INC
KY61-1427889OtherCHA
KY61-1427889OtherHUMANA
KY61-1427889OtherUHC
KY030670000OtherBLACK LUNG
KYP00314943OtherRRMCR
KY61-1427889OtherTRICARE
KY50008567OtherPASSPORT HEALTH PLAN
KY74026675Medicaid
KY0736539Medicare ID - Type Unspecified