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NPI Code Detail

MEDICARE: KELLI KEENE SANDERS, MD INC

MEDICARE: KELLI KEENE SANDERS, MD INC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine Physician

General Provider Information

NPI Number : 1003169111
Entity Type Code : Organization
Provider Name (Legal Business Name) : KELLI KEENE SANDERS, MD INC
Provider Business Mailing Address
First Line : 505 W PERSHING BLVD STE B
Second Line :
City : NORTH LITTLE ROCK
State : AR
Zip : 72114-2157
Country : US
Telephone Number : 501-753-1881
Fax Number : 501-753-2133
Provider Business Practice Location Address
First Line : 505 W PERSHING BLVD STE B
Second Line :
City : NORTH LITTLE ROCK
State : AR
Zip : 72114-2157
Country : US
Telephone Number : 501-753-1881
Fax Number : 501-753-2133
Authorized Official
Title or Position : CEO
Name : DR. KELLI KEENE SANDERS
Credential : MD
Telephone Number : 501-753-1881
Provider Enumeration Date : 10/26/2012
Last Update Date : 10/26/2012

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Directions to “KELLI KEENE SANDERS, MD INC ” Practice Location

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