Provider Demographics
NPI:1295111706
Name:FOGG, SALLY ANN (APRN)
Entity type:Individual
Prefix:
First Name:SALLY
Middle Name:ANN
Last Name:FOGG
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:SALLY
Other - Middle Name:ANN
Other - Last Name:GRENOBLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2620 ELM HILL PIKE
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37214-3108
Mailing Address - Country:US
Mailing Address - Phone:615-425-4200
Mailing Address - Fax:
Practice Address - Street 1:185 ADAM SHEPHERD PKWY
Practice Address - Street 2:
Practice Address - City:SHEPHERDSVILLE
Practice Address - State:KY
Practice Address - Zip Code:40165-6578
Practice Address - Country:US
Practice Address - Phone:502-921-5450
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-06
Last Update Date:2015-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3009396363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily