Provider Demographics
NPI:1447579495
Name:SANDERS, ALBERT H (NP-C)
Entity Type:Individual
Prefix:
First Name:ALBERT
Middle Name:H
Last Name:SANDERS
Suffix:
Gender:M
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2274 HIGHWAY 43 S
Mailing Address - Street 2:
Mailing Address - City:PICAYUNE
Mailing Address - State:MS
Mailing Address - Zip Code:39466-8141
Mailing Address - Country:US
Mailing Address - Phone:601-798-3989
Mailing Address - Fax:601-798-3964
Practice Address - Street 1:2274 HIGHWAY 43 S
Practice Address - Street 2:
Practice Address - City:PICAYUNE
Practice Address - State:MS
Practice Address - Zip Code:39466-8141
Practice Address - Country:US
Practice Address - Phone:601-798-3989
Practice Address - Fax:601-798-3964
Is Sole Proprietor?:No
Enumeration Date:2010-05-28
Last Update Date:2014-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR877250363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS09372043Medicaid
LA2130145Medicaid
MS9260512OtherAETNA
MS12123429OtherCAQH ID NUMBER
MSP00964914OtherRAIL ROAD MEDICARE
LA2130145Medicaid