Provider Demographics
NPI:1538190459
Name:BREEDING, SANDRA L (APRN)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:L
Last Name:BREEDING
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:805 NEWTOWN CIR STE A
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40511-1240
Mailing Address - Country:US
Mailing Address - Phone:859-288-2483
Mailing Address - Fax:859-288-2455
Practice Address - Street 1:805 NEWTOWN CIR STE A
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40511-1240
Practice Address - Country:US
Practice Address - Phone:859-288-2483
Practice Address - Fax:859-288-2455
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2013-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4094P363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY78010881Medicaid
P95441Medicare UPIN
KY0727002Medicare ID - Type Unspecified