Provider Demographics
NPI:1790063592
Name:UTSEY, SANDRA ELDER (APRN)
Entity Type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:ELDER
Last Name:UTSEY
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:MISS
Other - First Name:SANDRA
Other - Middle Name:MICHELLE
Other - Last Name:ELDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:PO BOX 950202
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40295-0202
Mailing Address - Country:US
Mailing Address - Phone:502-588-9490
Mailing Address - Fax:502-272-5116
Practice Address - Street 1:200 E CHESTNUT ST STE 303
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-1831
Practice Address - Country:US
Practice Address - Phone:502-629-5552
Practice Address - Fax:502-629-3132
Is Sole Proprietor?:No
Enumeration Date:2011-07-27
Last Update Date:2018-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1076668163W00000X
KY3006888363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000057121KDOtherHUMANA - NRP
IN201034670Medicaid
KY7100183390Medicaid
KY000000726728OtherANTHEM - NRP
KY127895OtherSIHO - NRP
KY50034295OtherPASSPORT - NRP
KY50034295OtherPASSPORT - NRP