Provider Demographics
NPI:1215196068
Name:WITHERS, SANDRA LYNN
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:LYNN
Last Name:WITHERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 MARSHALL ST
Mailing Address - Street 2:KIDS FIRST, ACH SLOT 900
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72202-3510
Mailing Address - Country:US
Mailing Address - Phone:501-364-6594
Mailing Address - Fax:
Practice Address - Street 1:800 MARSHALL ST
Practice Address - Street 2:KIDS FIRST, ACH, SLOT 900
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72202-3510
Practice Address - Country:US
Practice Address - Phone:501-364-6594
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-06
Last Update Date:2008-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA01053ANP363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics