Provider Demographics
NPI:1679573208
Name:MCGEEHAN, SALLY WADDLE (NP)
Entity Type:Individual
Prefix:
First Name:SALLY
Middle Name:WADDLE
Last Name:MCGEEHAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:206 E OAK ST
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:KY
Mailing Address - Zip Code:42501-1421
Mailing Address - Country:US
Mailing Address - Phone:606-678-0783
Mailing Address - Fax:
Practice Address - Street 1:9800 SHELBYVILLE RD
Practice Address - Street 2:SUITE #220
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40223-2977
Practice Address - Country:US
Practice Address - Phone:502-429-8585
Practice Address - Fax:502-753-0889
Is Sole Proprietor?:No
Enumeration Date:2005-07-26
Last Update Date:2010-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY298P363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY78001013Medicaid
KY1881785947OtherGROUP NPI
KY78001013Medicaid
KY30005117Medicare PIN
KYR38151Medicare UPIN