Provider Demographics
NPI:1861490773
Name:DEMPSEY, SANDRA KAY (PA - C)
Entity Type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:KAY
Last Name:DEMPSEY
Suffix:
Gender:F
Credentials:PA - C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 W ELDON ST
Mailing Address - Street 2:
Mailing Address - City:SAINT JAMES
Mailing Address - State:MO
Mailing Address - Zip Code:65559-1903
Mailing Address - Country:US
Mailing Address - Phone:573-265-1818
Mailing Address - Fax:573-265-1810
Practice Address - Street 1:107 W ELDON ST
Practice Address - Street 2:
Practice Address - City:SAINT JAMES
Practice Address - State:MO
Practice Address - Zip Code:65559-1903
Practice Address - Country:US
Practice Address - Phone:573-265-1818
Practice Address - Fax:573-265-1810
Is Sole Proprietor?:No
Enumeration Date:2005-07-13
Last Update Date:2009-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2002018245363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00635678OtherRAILROAD MEDICARE
431560263OtherTRICARE WEST
431560263OtherTRICARE WEST
P00635678OtherRAILROAD MEDICARE
000085555Medicare ID - Type Unspecified
MO000097549Medicare PIN