Provider Demographics
NPI:1376058883
Name:EVANS, SARAH GREENWELL (APRN-NP)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:GREENWELL
Last Name:EVANS
Suffix:
Gender:F
Credentials:APRN-NP
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:ELIZABETH
Other - Last Name:GREENWELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN-NP
Mailing Address - Street 1:PO BOX 936
Mailing Address - Street 2:
Mailing Address - City:LONDON
Mailing Address - State:KY
Mailing Address - Zip Code:40743-0936
Mailing Address - Country:US
Mailing Address - Phone:606-330-7818
Mailing Address - Fax:606-330-7825
Practice Address - Street 1:110 S SALEM DR
Practice Address - Street 2:
Practice Address - City:BARDSTOWN
Practice Address - State:KY
Practice Address - Zip Code:40004-1761
Practice Address - Country:US
Practice Address - Phone:502-350-5081
Practice Address - Fax:502-349-4745
Is Sole Proprietor?:No
Enumeration Date:2017-12-06
Last Update Date:2021-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3011730363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYK241880OtherKY MEDICARE