Provider Demographics
NPI:1316578818
Name:SANDERS, KAYLIN RAE (PA-C)
Entity Type:Individual
Prefix:
First Name:KAYLIN
Middle Name:RAE
Last Name:SANDERS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:KAYLIN
Other - Middle Name:RAE
Other - Last Name:YOUNGS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 10152
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37939-0152
Mailing Address - Country:US
Mailing Address - Phone:530-351-5595
Mailing Address - Fax:
Practice Address - Street 1:375 SMILE PL STE B
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-3653
Practice Address - Country:US
Practice Address - Phone:530-221-3376
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-03
Last Update Date:2020-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant