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General NPI Number Information
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NPI Number | 1841710530
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Entity Type | Individual
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Provider Name | KASIN MAYNE SANDERS PA-C
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Gender | Male
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Dates
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Enumeration Date | 06/22/2017
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Last Update Date | 11/19/2024
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Provider Practice Location Address
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Address Line | 8508 W GAGE BLVD STE A101
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City | KENNEWICK
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State | WA
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Zip | 99336-8106
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Country | US
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Telephone | 877-522-1275
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Fax | 833-888-7145
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Provider Business Mailing Address
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Address Line | 718 CHESTNUT OAK DR
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City | KNOXVILLE
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State | TN
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Zip | 37909-3453
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Country | US
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Telephone | 931-242-0937
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 1137867
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License Number State | TN
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