Provider Demographics
NPI:1467145367
Name:SANDERSON, ELISABETH BURNETT (APRN PMHNP)
Entity type:Individual
Prefix:
First Name:ELISABETH
Middle Name:BURNETT
Last Name:SANDERSON
Suffix:
Gender:F
Credentials:APRN PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8206 HIGHVIEW CT
Mailing Address - Street 2:
Mailing Address - City:CRESTWOOD
Mailing Address - State:KY
Mailing Address - Zip Code:40014-8105
Mailing Address - Country:US
Mailing Address - Phone:502-243-9559
Mailing Address - Fax:
Practice Address - Street 1:8206 HIGHVIEW CT
Practice Address - Street 2:
Practice Address - City:CRESTWOOD
Practice Address - State:KY
Practice Address - Zip Code:40014-8105
Practice Address - Country:US
Practice Address - Phone:502-243-9559
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-29
Last Update Date:2025-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4004956363LP0808X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner