Provider Demographics
NPI:1134434095
Name:SARGENT, EMILY ANN (APRN)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:ANN
Last Name:SARGENT
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1595
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41105-1595
Mailing Address - Country:US
Mailing Address - Phone:606-408-6200
Mailing Address - Fax:606-408-6612
Practice Address - Street 1:10650 US ROUTE 60
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41102-9611
Practice Address - Country:US
Practice Address - Phone:606-408-6301
Practice Address - Fax:606-408-6350
Is Sole Proprietor?:No
Enumeration Date:2010-08-16
Last Update Date:2015-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3006494363LF0000X
OH11673-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810018387Medicaid
KYP00873780OtherRR MEDICARE
OH3080606Medicaid
KY7100127370Medicaid
OHP01050730OtherRR MEDICARE
OH3080606Medicaid
KY7100127370Medicaid