=====================================================
General NPI Number Information
=====================================================
NPI Number | 1891514006
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DARRELL SANDERS
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/04/2024
-----------------------------------------------------
Last Update Date | 10/04/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 17440 HENDERSON PASS
-----------------------------------------------------
City | SAN ANTONIO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78232-1662
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 210-483-5916
-----------------------------------------------------
Fax | 210-483-5923
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 17440 HENDERSON PASS
-----------------------------------------------------
City | SAN ANTONIO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78232-1662
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 210-483-5916
-----------------------------------------------------
Fax | 210-483-5923
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 163WP0809X
-----------------------------------------------------
Taxonomy Name | Adult Psychiatric/Mental Health Registered Nurse
-----------------------------------------------------
License Number | RN108223
-----------------------------------------------------
License Number State | LA
-----------------------------------------------------