Provider Demographics
NPI:1588608038
Name:SANDERS, PAULA ANN (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:PAULA
Middle Name:ANN
Last Name:SANDERS
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1120 MONTGOMERY COUNTY LINE RD
Mailing Address - Street 2:
Mailing Address - City:CUNNINGHAM
Mailing Address - State:TN
Mailing Address - Zip Code:37052-6002
Mailing Address - Country:US
Mailing Address - Phone:615-516-5719
Mailing Address - Fax:615-446-3760
Practice Address - Street 1:721 HIGHWAY 46 S
Practice Address - Street 2:
Practice Address - City:DICKSON
Practice Address - State:TN
Practice Address - Zip Code:37055-2565
Practice Address - Country:US
Practice Address - Phone:615-446-3797
Practice Address - Fax:615-446-3760
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN 0000007659363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3902592Medicaid
TN4017177OtherBLUE CROSS BLUE SHIELD
TN9394246OtherPHCS
TN3902592Medicaid