Basic Information
| Provider Information | |||||||||
| NPI: | 1609298512 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HOOVER | ||||||||
| FirstName: | SARA | ||||||||
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| Credential: | CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4500 KIDWELL LN | ||||||||
| Address2: | |||||||||
| City: | FT WRIGHT | ||||||||
| State: | KY | ||||||||
| PostalCode: | 410179217 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6168626186 | ||||||||
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| Practice Location | |||||||||
| Address1: | 20 MEDICAL VILLAGE DR | ||||||||
| Address2: | STE. 258 | ||||||||
| City: | EDGEWOOD | ||||||||
| State: | KY | ||||||||
| PostalCode: | 410175401 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8593012211 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/11/2014 | ||||||||
| LastUpdateDate: | 06/09/2014 | ||||||||
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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 | 163W00000X | 80642 | WV | N | Nursing Service Providers | Registered Nurse | 163W00000X | 4704254150 | MI | N | Nursing Service Providers | Registered Nurse | 163W00000X | 1138560 | KY | N | Nursing Service Providers | Registered Nurse | 367500000X | 93278 | KY | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
No ID Information.