Provider Demographics
NPI:1699869404
Name:SANDERS, JAMI (PA-C)
Entity type:Individual
Prefix:
First Name:JAMI
Middle Name:
Last Name:SANDERS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:807 N MONTE VISTA ST
Mailing Address - Street 2:WOMEN'S HEALTH CENTER
Mailing Address - City:ADA
Mailing Address - State:OK
Mailing Address - Zip Code:74820-7711
Mailing Address - Country:US
Mailing Address - Phone:580-332-8855
Mailing Address - Fax:580-332-7374
Practice Address - Street 1:807 N MONTE VISTA ST
Practice Address - Street 2:WOMEN'S HEALTH CENTER
Practice Address - City:ADA
Practice Address - State:OK
Practice Address - Zip Code:74820-7711
Practice Address - Country:US
Practice Address - Phone:580-332-8855
Practice Address - Fax:580-332-7374
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2024-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1072363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100126550AMedicaid
OK100126550AMedicaid