Healthcare Provider Details

I. General information

NPI: 1417743972
Provider Name (Legal Business Name): KYLIE GUEST SANDERS MSN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2025
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

930 FRANKLIN SPRINGS ST STE F
ROYSTON GA
30662-3908
US

IV. Provider business mailing address

2505 HARRISON AVE
PANAMA CITY FL
32405-4423
US

V. Phone/Fax

Practice location:
  • Phone: 877-231-3376
  • Fax: 850-522-8354
Mailing address:
  • Phone: 877-231-3376
  • Fax: 850-522-8354

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN-NP313709
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: