Healthcare Provider Details

I. General information

NPI: 1811234594
Provider Name (Legal Business Name): AMY JEANETTE SANDERS NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/15/2013
Last Update Date: 01/16/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4300 W 7TH ST
LITTLE ROCK AR
72205-5446
US

IV. Provider business mailing address

30 BURTON HILLS BLVD STE 175
NASHVILLE TN
37215-6403
US

V. Phone/Fax

Practice location:
  • Phone: 501-257-6671
  • Fax:
Mailing address:
  • Phone: 615-988-2014
  • Fax: 615-864-7565

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberA003779
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: