Provider Demographics
NPI:1508366501
Name:SANDERSON, MONTY KATHLEEN
Entity Type:Individual
Prefix:MRS
First Name:MONTY
Middle Name:KATHLEEN
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 1:7732 WHITE PLAINS AVE
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79121-1774
Mailing Address - Country:US
Mailing Address - Phone:806-681-8467
Mailing Address - Fax:
Practice Address - Street 1:7732 WHITE PLAINS AVE
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79121-1774
Practice Address - Country:US
Practice Address - Phone:806-681-8467
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-15
Last Update Date:2018-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant