Healthcare Provider Details

I. General information

NPI: 1336529403
Provider Name (Legal Business Name): KAYLA R SANDERS APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KAYLA R HENDRIX

II. Dates (important events)

Enumeration Date: 06/04/2015
Last Update Date: 06/16/2021
Certification Date: 06/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

502 RICHIE RD
CABOT AR
72023
US

IV. Provider business mailing address

PO BOX 497
AUGUSTA AR
72006-0497
US

V. Phone/Fax

Practice location:
  • Phone: 501-941-0940
  • Fax: 501-941-1875
Mailing address:
  • Phone: 870-347-2534
  • Fax: 870-347-2023

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberA004417
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: