MEDICARE: KEVIN S SANDERS PSY.D.

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
1	103T00000X	Psychologist	007470	AR
2	103TC0700X	Clinical Psychologist	2003015983	MO

General Provider Information

NPI Number	:	1760569362
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEVIN S SANDERS PSY.D.

Provider Business Mailing Address
First Line	:	PO BOX 85
Second Line	:
City	:	KIMBERLING CITY
State	:	MO
Zip	:	65686-0085
Country	:	US
Telephone Number	:	417-739-3325
Fax Number	:	417-739-3326

Provider Business Practice Location Address
First Line	:	15060 STATE HIGHWAY 13
Second Line	:	SUITE 2
City	:	REEDS SPRING
State	:	MO
Zip	:	65737-8652
Country	:	US
Telephone Number	:	417-739-3325
Fax Number	:	417-739-3326

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/01/2006
Last Update Date	:	09/11/2025

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