Provider Demographics
NPI:1124256946
Name:SANDERS, KEVIN DENARD SR (CST,CFA)
Entity type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:DENARD
Last Name:SANDERS
Suffix:SR
Gender:M
Credentials:CST,CFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:603 CROSS MEADOW BLVD
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-8696
Mailing Address - Country:US
Mailing Address - Phone:817-477-9114
Mailing Address - Fax:817-477-9114
Practice Address - Street 1:603 CROSS MEADOW BLVD
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-8696
Practice Address - Country:US
Practice Address - Phone:817-477-9114
Practice Address - Fax:817-477-9114
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-01
Last Update Date:2009-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX109489246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant