Provider Demographics
NPI:1659963478
Name:SANDERS, JENNIFER RENEE' (APRN, FNP-C)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:RENEE'
Last Name:SANDERS
Suffix:
Gender:F
Credentials:APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 909
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40201-0909
Mailing Address - Country:US
Mailing Address - Phone:502-588-0328
Mailing Address - Fax:
Practice Address - Street 1:401 E CHESTNUT ST UNIT 510
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-5710
Practice Address - Country:US
Practice Address - Phone:502-588-4740
Practice Address - Fax:502-588-9537
Is Sole Proprietor?:No
Enumeration Date:2021-02-04
Last Update Date:2021-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28243412A363LF0000X
KY3016363363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300053150Medicaid
KY7100751100Medicaid