Provider Demographics
NPI:1750532867
Name:ERVIN, SARAH D (PA-C)
Entity type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:D
Last Name:ERVIN
Suffix:
Gender:
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:433 FAIRHOLME WAY
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:KY
Mailing Address - Zip Code:40391-8364
Mailing Address - Country:US
Mailing Address - Phone:606-923-5423
Mailing Address - Fax:
Practice Address - Street 1:404 SHOPPERS DR
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:KY
Practice Address - Zip Code:40391-1301
Practice Address - Country:US
Practice Address - Phone:859-737-5333
Practice Address - Fax:859-737-0070
Is Sole Proprietor?:No
Enumeration Date:2008-10-07
Last Update Date:2025-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPA1090363AM0700X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100109890Medicaid
KYK080431Medicare PIN