Provider Demographics
NPI:1124490370
Name:CHASTEEN, SARA (PA-C)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:CHASTEEN
Suffix:
Gender:F
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 1:5200 COMMERCE CROSSING
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40229-2182
Mailing Address - Country:US
Mailing Address - Phone:502-253-4900
Mailing Address - Fax:502-489-5751
Practice Address - Street 1:60 BRYAN BLVD STE 200
Practice Address - Street 2:
Practice Address - City:CORBIN
Practice Address - State:KY
Practice Address - Zip Code:40701-2781
Practice Address - Country:US
Practice Address - Phone:606-528-1172
Practice Address - Fax:606-528-7169
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-28
Last Update Date:2020-12-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KYPA2069363A00000X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYP01564509OtherRAILROAD MEDICARE
KY7100387510Medicaid
KYK198340Medicare PIN