Provider Demographics
NPI:1821201823
Name:DUNCAN, SANDY GAYLE
Entity type:Individual
Prefix:
First Name:SANDY
Middle Name:GAYLE
Last Name:DUNCAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:729 JOHNSON SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:MUNFORDVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42765-9322
Mailing Address - Country:US
Mailing Address - Phone:270-524-0997
Mailing Address - Fax:270-524-0999
Practice Address - Street 1:729 JOHNSON SPRINGS RD
Practice Address - Street 2:
Practice Address - City:MUNFORDVILLE
Practice Address - State:KY
Practice Address - Zip Code:42765-9322
Practice Address - Country:US
Practice Address - Phone:270-524-0997
Practice Address - Fax:270-524-0999
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY-1049146163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYKY-1049146Medicaid