Healthcare Provider Details

I. General information

NPI: 1457373664
Provider Name (Legal Business Name): TERRY GAY SANDERS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2006
Last Update Date: 02/10/2020
Certification Date: 02/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5247 DIDESSE DR
BATON ROUGE LA
70808-9153
US

IV. Provider business mailing address

8300 JO LEE DR
DENHAM SPRINGS LA
70706-8539
US

V. Phone/Fax

Practice location:
  • Phone: 225-765-3076
  • Fax: 225-765-3090
Mailing address:
  • Phone: 225-937-4086
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberA10174
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: