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NPI Code Detail

MEDICARE: KYLE SANDERS-JEFFERSON NURSE PRACTITIONER

MEDICARE: KYLE SANDERS-JEFFERSON NURSE PRACTITIONER
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1163W00000XRegistered NurseRN121162GA
2363LF0000XFamily Nurse PractitionerRN121162GA
3363LF0000XFamily Nurse Practitioner28606SC

General Provider Information

NPI Number : 1235536533
Entity Type Code : Individual
Provider Name (Legal Business Name) : KYLE SANDERS-JEFFERSON NURSE PRACTITIONER
Provider Business Mailing Address
First Line : PO BOX 231
Second Line :
City : HINESVILLE
State : GA
Zip : 31310-0231
Country : US
Telephone Number : 912-876-2173
Fax Number : 912-876-2346
Provider Business Practice Location Address
First Line : 1113 E OGLETHORPE HWY
Second Line :
City : HINESVILLE
State : GA
Zip : 31313-1200
Country : US
Telephone Number : 912-876-2173
Fax Number : 912-876-2346
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/02/2014
Last Update Date : 01/06/2026

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