Healthcare Provider Details

I. General information

NPI: 1033675376
Provider Name (Legal Business Name): CHARIE ANN SANDS PLPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHARIE ANN WALKER

II. Dates (important events)

Enumeration Date: 02/12/2019
Last Update Date: 07/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 S ELM ST
NEVADA MO
64772-3413
US

IV. Provider business mailing address

1107 BROADWAY ST
LAMAR MO
64759-1758
US

V. Phone/Fax

Practice location:
  • Phone: 417-682-5757
  • Fax: 417-682-5757
Mailing address:
  • Phone: 417-682-5757
  • Fax: 417-682-5757

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number000245
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number2019004030
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: