Provider Demographics
NPI:1992338818
Name:CONGLETON, SARAH ANGELINA (PA-C)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:ANGELINA
Last Name:CONGLETON
Suffix:
Gender:
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 1:2251 WAR ADMIRAL WAY STE 125
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40509-2546
Mailing Address - Country:US
Mailing Address - Phone:859-554-8486
Mailing Address - Fax:859-368-8920
Practice Address - Street 1:2251 WAR ADMIRAL WAY STE 125
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40509-2546
Practice Address - Country:US
Practice Address - Phone:586-554-8486
Practice Address - Fax:859-368-8920
Is Sole Proprietor?:No
Enumeration Date:2020-02-19
Last Update Date:2025-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPA2501207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine