Provider Demographics
NPI:1427009711
Name:CAGATA, SIBYL C (ARNP)
Entity Type:Individual
Prefix:MISS
First Name:SIBYL
Middle Name:C
Last Name:CAGATA
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 776347
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-6347
Mailing Address - Country:US
Mailing Address - Phone:502-899-3366
Mailing Address - Fax:502-899-3455
Practice Address - Street 1:3991 DUTCHMANS LN
Practice Address - Street 2:SUITE 405
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-4700
Practice Address - Country:US
Practice Address - Phone:502-899-3366
Practice Address - Fax:502-899-3455
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2018-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3050P363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY500012702OtherRAILROAD MEDICARE
KY000000174112OtherANTHEM PROVIDER NO.
KY124095OtherPASSPORT PROVIDER NO
KY78003712Medicaid
KY124095OtherPASSPORT PROVIDER NO
KYP07041Medicare UPIN