Provider Demographics
NPI:1003804956
Name:SANDERS, JUDY C (ARNP/CNM)
Entity Type:Individual
Prefix:MRS
First Name:JUDY
Middle Name:C
Last Name:SANDERS
Suffix:
Gender:F
Credentials:ARNP/CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7901 S SHERIDAN RD
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74133-8900
Mailing Address - Country:US
Mailing Address - Phone:918-710-4112
Mailing Address - Fax:918-710-4118
Practice Address - Street 1:7901 S SHERIDAN RD
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133-8900
Practice Address - Country:US
Practice Address - Phone:918-710-4112
Practice Address - Fax:918-710-4118
Is Sole Proprietor?:No
Enumeration Date:2005-10-13
Last Update Date:2015-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0093602363LF0000X, 367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200222810AMedicaid
93602OtherSTATE LICENSE
93602OtherSTATE LICENSE