Provider Demographics
NPI:1518201722
Name:NOLAN, SARAH B (LPP)
Entity Type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:B
Last Name:NOLAN
Suffix:
Gender:F
Credentials:LPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2025 REGENCY RD STE 100
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40503-2361
Mailing Address - Country:US
Mailing Address - Phone:859-618-2476
Mailing Address - Fax:
Practice Address - Street 1:2025 REGENCY RD STE 100
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503-2361
Practice Address - Country:US
Practice Address - Phone:859-618-2476
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-15
Last Update Date:2022-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1016103T00000X
KY240323103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1790731081Medicaid