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NPI Code Detail

MEDICARE: KELLY SANDERS

MEDICARE: KELLY SANDERS
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
1363L00000XNurse Practitioner31308SC

General Provider Information

NPI Number : 1013869973
Entity Type Code : Individual
Provider Name (Legal Business Name) : KELLY SANDERS
Provider Business Mailing Address
First Line : 1029 W MEETING ST
Second Line :
City : LANCASTER
State : SC
Zip : 29720-2205
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1029 W MEETING ST
Second Line :
City : LANCASTER
State : SC
Zip : 29720-2205
Country : US
Telephone Number : 803-285-2041
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/12/2026
Last Update Date : 02/12/2026

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Directions to “ KELLY SANDERS ” Practice Location

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