Provider Demographics
NPI:1386051068
Name:PENCE, SARA BETH (APRN, FNP-BC)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:BETH
Last Name:PENCE
Suffix:
Gender:F
Credentials:APRN, FNP-BC
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:BETH
Other - Last Name:BULLOCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:650 SOUTH HIGHWAY 27 #308
Mailing Address - Street 2:SUITE 5
Mailing Address - City:SOMERSET
Mailing Address - State:KY
Mailing Address - Zip Code:42501
Mailing Address - Country:US
Mailing Address - Phone:606-331-5328
Mailing Address - Fax:859-207-6700
Practice Address - Street 1:100 HARDIN LN STE 3.5
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:KY
Practice Address - Zip Code:42503-3812
Practice Address - Country:US
Practice Address - Phone:606-331-5328
Practice Address - Fax:859-207-6700
Is Sole Proprietor?:No
Enumeration Date:2014-07-15
Last Update Date:2023-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3008771363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100335730Medicaid
KY7100872480Medicaid