Provider Demographics
NPI:1588947147
Name:SANDER, KERRY A (NURSE PRACTITIONER)
Entity type:Individual
Prefix:
First Name:KERRY
Middle Name:A
Last Name:SANDER
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16191 S BROOKFIELD ST
Mailing Address - Street 2:
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66062-3927
Mailing Address - Country:US
Mailing Address - Phone:913-634-2398
Mailing Address - Fax:
Practice Address - Street 1:7500 W 160TH ST
Practice Address - Street 2:
Practice Address - City:STILWELL
Practice Address - State:KS
Practice Address - Zip Code:66085-8100
Practice Address - Country:US
Practice Address - Phone:913-814-8000
Practice Address - Fax:913-948-5206
Is Sole Proprietor?:No
Enumeration Date:2011-09-21
Last Update Date:2024-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS53-75518-082363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care