Provider Demographics
NPI:1336477959
Name:CHAPMAN, SALLY MUDD (RN)
Entity Type:Individual
Prefix:
First Name:SALLY
Middle Name:MUDD
Last Name:CHAPMAN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:465 E HIGH ST
Mailing Address - Street 2:SUITE 208
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40507-1938
Mailing Address - Country:US
Mailing Address - Phone:859-258-2733
Mailing Address - Fax:
Practice Address - Street 1:465 E HIGH ST
Practice Address - Street 2:SUITE 208
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40507-1938
Practice Address - Country:US
Practice Address - Phone:859-258-2733
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-11-19
Last Update Date:2009-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1028494163W00000X, 163WC0400X, 163WM1400X, 163WP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WC0400XNursing Service ProvidersRegistered NurseCase Management
No163WM1400XNursing Service ProvidersRegistered NurseNurse Massage Therapist (NMT)
No163WP0000XNursing Service ProvidersRegistered NursePain Management