Provider Demographics
NPI:1376503136
Name:MAXWELL-SAMMONS, SARAH (PA-C)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:MAXWELL-SAMMONS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:
Other - Last Name:MAXWELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:789 EASTERN BYPASS
Mailing Address - Street 2:SUITE 5
Mailing Address - City:RICHMOND
Mailing Address - State:KY
Mailing Address - Zip Code:40475-7985
Mailing Address - Country:US
Mailing Address - Phone:859-624-4110
Mailing Address - Fax:859-624-1968
Practice Address - Street 1:789 EASTERN BYPASS
Practice Address - Street 2:SUITE 5
Practice Address - City:RICHMOND
Practice Address - State:KY
Practice Address - Zip Code:40475-7985
Practice Address - Country:US
Practice Address - Phone:859-624-4110
Practice Address - Fax:859-624-1968
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2014-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPA879363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY95005971Medicaid
KYK026150Medicare PIN