Provider Demographics
NPI:1689665333
Name:SIEBERT, SALLY GAY (FNP PNP)
Entity Type:Individual
Prefix:
First Name:SALLY
Middle Name:GAY
Last Name:SIEBERT
Suffix:
Gender:F
Credentials:FNP PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1199 BAKERS LN
Mailing Address - Street 2:
Mailing Address - City:NICHOLASVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40356-8716
Mailing Address - Country:US
Mailing Address - Phone:859-887-2350
Mailing Address - Fax:
Practice Address - Street 1:650 NEWTOWN PIKE
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40508-1197
Practice Address - Country:US
Practice Address - Phone:859-252-2371
Practice Address - Fax:859-288-2468
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1038432363LF0000X, 363LP0200X
KY308P363LF0000X, 363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Not Answered363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY78002599Medicaid
KY78002599Medicaid
S90995Medicare UPIN