Healthcare Provider Details

I. General information

NPI: 1730263203
Provider Name (Legal Business Name): JERRY KENT SANDERS RNFA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/24/2006
Last Update Date: 12/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7200 CATHEDRAL ROCK DR SUITE 210
LAS VEGAS NV
89128-0438
US

IV. Provider business mailing address

7326 W CHEYENNE AVE
LAS VEGAS NV
89129-6201
US

V. Phone/Fax

Practice location:
  • Phone: 702-430-5000
  • Fax: 702-363-9164
Mailing address:
  • Phone: 702-499-3828
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License NumberRN42954
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: