Provider Demographics
NPI:1417382235
Name:SANDERSON, KARI COLLEEN
Entity Type:Individual
Prefix:
First Name:KARI
Middle Name:COLLEEN
Last Name:SANDERSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 N OAK ST STE C
Mailing Address - Street 2:
Mailing Address - City:SHERIDAN
Mailing Address - State:AR
Mailing Address - Zip Code:72150-2100
Mailing Address - Country:US
Mailing Address - Phone:870-942-4092
Mailing Address - Fax:870-942-4092
Practice Address - Street 1:202 N OAK ST STE C
Practice Address - Street 2:
Practice Address - City:SHERIDAN
Practice Address - State:AR
Practice Address - Zip Code:72150-2100
Practice Address - Country:US
Practice Address - Phone:870-942-4092
Practice Address - Fax:870-942-4092
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-11
Last Update Date:2013-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility