Provider Demographics
NPI:1982294450
Name:SANDERSON, KARA MARIE (APRN, PMHNP)
Entity type:Individual
Prefix:
First Name:KARA
Middle Name:MARIE
Last Name:SANDERSON
Suffix:
Gender:F
Credentials:APRN, PMHNP
Other - Prefix:
Other - First Name:KARA
Other - Middle Name:MARIE
Other - Last Name:SANDERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:KARA HENDRICKSON
Mailing Address - Street 1:3220 223RD ST W
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55024-4004
Mailing Address - Country:US
Mailing Address - Phone:319-883-6431
Mailing Address - Fax:
Practice Address - Street 1:615 1ST AVE NE STE 310
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55413-2419
Practice Address - Country:US
Practice Address - Phone:612-436-0295
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-19
Last Update Date:2024-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2245698163WP0808X
MN11908363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health