Basic Information
| Provider Information | |||||||||
| NPI: | 1134434095 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SARGENT | ||||||||
| FirstName: | EMILY | ||||||||
| MiddleName: | ANN | ||||||||
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| Credential: | APRN | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1595 | ||||||||
| Address2: | |||||||||
| City: | ASHLAND | ||||||||
| State: | KY | ||||||||
| PostalCode: | 411051595 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6064086200 | ||||||||
| FaxNumber: | 6064086612 | ||||||||
| Practice Location | |||||||||
| Address1: | 10650 US ROUTE 60 | ||||||||
| Address2: | |||||||||
| City: | ASHLAND | ||||||||
| State: | KY | ||||||||
| PostalCode: | 411029611 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6064086301 | ||||||||
| FaxNumber: | 6064086350 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/16/2010 | ||||||||
| LastUpdateDate: | 05/06/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 3006494 | KY | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 363LF0000X | 11673-NP | OH | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 3810018387 | 05 | WV | MEDICAID | P00873780 | 01 | KY | RR MEDICARE | OTHER | 3080606 | 05 | OH | MEDICAID | 7100127370 | 05 | KY | MEDICAID | P01050730 | 01 | OH | RR MEDICARE | OTHER |