Provider Demographics
NPI:1700186343
Name:BRASWELL, SANDRA LEE (APRN)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:LEE
Last Name:BRASWELL
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:SANDRA
Other - Middle Name:LEE
Other - Last Name:GILBERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:126 FRANKLIN DRIVE
Mailing Address - Street 2:
Mailing Address - City:MONTICELLO
Mailing Address - State:KY
Mailing Address - Zip Code:42633
Mailing Address - Country:US
Mailing Address - Phone:606-396-3534
Mailing Address - Fax:606-396-3535
Practice Address - Street 1:126 FRANKLIN DRIVE
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:KY
Practice Address - Zip Code:42633-2245
Practice Address - Country:US
Practice Address - Phone:606-396-3534
Practice Address - Fax:606-396-3535
Is Sole Proprietor?:No
Enumeration Date:2010-10-29
Last Update Date:2022-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3006692363LP0808X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYK034670Medicare PIN