Basic Information
| Provider Information | |||||||||
| NPI: | 1578529665 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PRICE | ||||||||
| FirstName: | SONDRA | ||||||||
| MiddleName: | U | ||||||||
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| Credential: | ARNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1717 HIGH ST | ||||||||
| Address2: | SUITE 3A | ||||||||
| City: | HOPKINSVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 422406300 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2708858445 | ||||||||
| FaxNumber: | 2708851216 | ||||||||
| Practice Location | |||||||||
| Address1: | 1717 HIGH ST | ||||||||
| Address2: | SUITE 3A | ||||||||
| City: | HOPKINSVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 422406300 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2708858445 | ||||||||
| FaxNumber: | 2708851216 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/26/2006 | ||||||||
| LastUpdateDate: | 09/05/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP0200X | 4549P | KY | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 000000367593 | 01 | ANTHEM | OTHER | 78013992 | 05 | KY | MEDICAID |