Provider Demographics
NPI:1699097592
Name:TABER, SANDRA GAIL (APRN)
Entity type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:GAIL
Last Name:TABER
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 1:619 N 30TH ST
Mailing Address - Street 2:
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42001-4047
Mailing Address - Country:US
Mailing Address - Phone:270-444-8183
Mailing Address - Fax:270-444-8147
Practice Address - Street 1:619 N 30TH ST
Practice Address - Street 2:
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42001-4047
Practice Address - Country:US
Practice Address - Phone:270-444-8183
Practice Address - Fax:270-444-8147
Is Sole Proprietor?:No
Enumeration Date:2010-02-18
Last Update Date:2016-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3006232364S00000X, 363L00000X
KY1040966163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000740558OtherANTHEM
KY7100190170Medicaid
KY7100170370Medicaid
KYP400039183Medicare PIN