Provider Demographics
NPI:1972617397
Name:SANDERS, KELLI KEENE (MD)
Entity type:Individual
Prefix:DR
First Name:KELLI
Middle Name:KEENE
Last Name:SANDERS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:505 W PERSHING BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:NORTH LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72114-2147
Mailing Address - Country:US
Mailing Address - Phone:501-753-1881
Mailing Address - Fax:501-753-2133
Practice Address - Street 1:505 W PERSHING BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:NORTH LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72114-2147
Practice Address - Country:US
Practice Address - Phone:501-753-1881
Practice Address - Fax:501-753-2133
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC 8464207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARF64056Medicare UPIN
AR5J193Medicare ID - Type Unspecified