Provider Demographics
NPI:1215095518
Name:SANDERS, KIMBERLY KAY (CRN FIRST ASSISTANT)
Entity type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:KAY
Last Name:SANDERS
Suffix:
Gender:F
Credentials:CRN FIRST ASSISTANT
Other - Prefix:MRS
Other - First Name:KIMBERLY
Other - Middle Name:KAY
Other - Last Name:KIGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:600 SUNCREST TOWNE CENTRE
Mailing Address - Street 2:SUITE 310
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26505-1872
Mailing Address - Country:US
Mailing Address - Phone:304-598-2200
Mailing Address - Fax:504-599-2674
Practice Address - Street 1:600 SUNCREST TOWNE CENTRE
Practice Address - Street 2:SUITE 310
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26505-1872
Practice Address - Country:US
Practice Address - Phone:304-598-2200
Practice Address - Fax:504-599-2674
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2009-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV40474163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0127488000Medicaid
WV0126752000Medicaid
WV0126874000Medicaid
WV0127974000Medicaid
WV3810011004Medicaid