Provider Demographics
NPI:1326446907
Name:SANDRA SPIERS, LLC
Entity Type:Organization
Organization Name:SANDRA SPIERS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:J
Authorized Official - Last Name:SPIERS
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:601-347-3029
Mailing Address - Street 1:107 WOODMONT DR
Mailing Address - Street 2:
Mailing Address - City:PICAYUNE
Mailing Address - State:MS
Mailing Address - Zip Code:39466-7658
Mailing Address - Country:US
Mailing Address - Phone:601-347-3029
Mailing Address - Fax:
Practice Address - Street 1:117 N MAIN ST STE B
Practice Address - Street 2:
Practice Address - City:PICAYUNE
Practice Address - State:MS
Practice Address - Zip Code:39466-3936
Practice Address - Country:US
Practice Address - Phone:601-347-3029
Practice Address - Fax:601-749-7100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-12
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS04778509Medicaid
MS2831390OtherUNITED HEALTH CARE
MSP00816371OtherRR MEDICARE
MS640507572OtherTRICARE
MS5121500067OtherMEDICARE