Provider Demographics
NPI:1710409370
Name:SLEEP IDENTITY PLLC
Entity Type:Organization
Organization Name:SLEEP IDENTITY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FRONT OFFICE ASSISTANT
Authorized Official - Prefix:MRS
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:STAPLETON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:859-287-2484
Mailing Address - Street 1:541 DARBY CREEK RD STE 190
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40509-2710
Mailing Address - Country:US
Mailing Address - Phone:859-287-2484
Mailing Address - Fax:859-287-2463
Practice Address - Street 1:541 DARBY CREEK ROAD
Practice Address - Street 2:STE 190
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40509
Practice Address - Country:US
Practice Address - Phone:859-287-2484
Practice Address - Fax:859-287-2463
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY9038261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental