Healthcare Provider Details

I. General information

NPI: 1356267819
Provider Name (Legal Business Name): JENIFER GAIL SANDERS BSN RN (NP STUDENT)
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2026
Last Update Date: 06/27/2026
Certification Date: 06/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 FITNESS WAY
ATHENS AL
35611-2480
US

IV. Provider business mailing address

109 SOUGAHATCHEE DR
NEW MARKET AL
35761-7807
US

V. Phone/Fax

Practice location:
  • Phone: 256-232-0636
  • Fax:
Mailing address:
  • Phone: 256-658-9575
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number1-068579
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: