Provider Demographics
NPI:1285222026
Name:SANDERS, KELLY JEAN (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:JEAN
Last Name:SANDERS
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:MS
Other - First Name:KELLY
Other - Middle Name:JEAN
Other - Last Name:PIZANA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-C
Mailing Address - Street 1:605 N 7TH ST
Mailing Address - Street 2:
Mailing Address - City:WOLFFORTH
Mailing Address - State:TX
Mailing Address - Zip Code:79382-3237
Mailing Address - Country:US
Mailing Address - Phone:806-781-7345
Mailing Address - Fax:
Practice Address - Street 1:1502 98TH ST
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79423-3273
Practice Address - Country:US
Practice Address - Phone:806-781-7345
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-07
Last Update Date:2022-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1020690363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily