Healthcare Provider Details

I. General information

NPI: 1487868923
Provider Name (Legal Business Name): KRISTIN KATHLEEN SANDS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2007
Last Update Date: 11/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

151 W 151ST ST
OLATHE KS
66061-5305
US

IV. Provider business mailing address

153 W 151ST ST SUITE 100
OLATHE KS
66061-5348
US

V. Phone/Fax

Practice location:
  • Phone: 913-764-1125
  • Fax: 913-764-1186
Mailing address:
  • Phone: 913-764-1125
  • Fax: 913-764-1186

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number2007006942
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number1501163
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: