MEDICARE: MR. JERRY KENT SANDERS RNFA

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
1	163WR0006X	Registered Nurse First Assistant	RN42954	NV

General Provider Information

NPI Number	:	1730263203
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JERRY KENT SANDERS RNFA

Provider Business Mailing Address
First Line	:	7326 W CHEYENNE AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89129-6201
Country	:	US
Telephone Number	:	702-499-3828
Fax Number	:

Provider Business Practice Location Address
First Line	:	7200 CATHEDRAL ROCK DR
Second Line	:	SUITE 210
City	:	LAS VEGAS
State	:	NV
Zip	:	89128-0438
Country	:	US
Telephone Number	:	702-430-5000
Fax Number	:	702-363-9164

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/24/2006
Last Update Date	:	12/06/2012

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