Provider Demographics
NPI:1043710478
Name:SANDERS, KRISTIE M (FNP-C)
Entity Type:Individual
Prefix:
First Name:KRISTIE
Middle Name:M
Last Name:SANDERS
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:138 MONKS RD
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37334-6008
Mailing Address - Country:US
Mailing Address - Phone:931-993-9233
Mailing Address - Fax:
Practice Address - Street 1:10 ELDAD RD
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:TN
Practice Address - Zip Code:37334-7005
Practice Address - Country:US
Practice Address - Phone:931-433-2229
Practice Address - Fax:931-433-2398
Is Sole Proprietor?:No
Enumeration Date:2018-02-12
Last Update Date:2018-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN23774207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine