Healthcare Provider Details

I. General information

NPI: 1043633696
Provider Name (Legal Business Name): JENNIFER C SANDERS FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/31/2014
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5221 GETWELL RD STE A
SOUTHAVEN MS
38671-1054
US

IV. Provider business mailing address

5221 GETWELL RD STE A
SOUTHAVEN MS
38671-1054
US

V. Phone/Fax

Practice location:
  • Phone: 662-469-5758
  • Fax: 662-214-6248
Mailing address:
  • Phone: 662-469-5758
  • Fax: 662-214-6248

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR817657
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: