Provider Demographics
NPI:1861638397
Name:SANFORD, JEAN (NP)
Entity Type:Individual
Prefix:
First Name:JEAN
Middle Name:
Last Name:SANFORD
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 1:7363 SULPHUR WELL KNOB LICK RD
Mailing Address - Street 2:
Mailing Address - City:KNOB LICK
Mailing Address - State:KY
Mailing Address - Zip Code:42154-8391
Mailing Address - Country:US
Mailing Address - Phone:270-453-3792
Mailing Address - Fax:
Practice Address - Street 1:7363 SULPHUR WELL KNOB LICK RD
Practice Address - Street 2:
Practice Address - City:KNOB LICK
Practice Address - State:KY
Practice Address - Zip Code:42154-8391
Practice Address - Country:US
Practice Address - Phone:270-453-3792
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-06
Last Update Date:2009-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY5570P363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily