Individual
STACEY SALE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
3303 FERN VALLEY RD, LOUISVILLE, KY 40213-3529
(502) 964-4889
(502) 964-9976
Mailing address
PO BOX 950248, LOUISVILLE, KY 40295-0248
(502) 489-5730
(502) 489-5751
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA1884
KY
363A00000X
Physician Assistant
TC258
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7100273800
—
KY
Enumeration date
02/10/2014
Last updated
12/01/2020
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