Provider Demographics
NPI:1871868000
Name:SANDERS, JASON PAUL (APRN-NA)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:PAUL
Last Name:SANDERS
Suffix:
Gender:M
Credentials:APRN-NA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 E LIBERTY ST
Mailing Address - Street 2:STE 800
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-1428
Mailing Address - Country:US
Mailing Address - Phone:502-361-6617
Mailing Address - Fax:502-361-6637
Practice Address - Street 1:1850 BLUEGRASS AVE
Practice Address - Street 2:ANESTHESIA DEPARTMENT
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40215-1161
Practice Address - Country:US
Practice Address - Phone:502-361-6617
Practice Address - Fax:502-361-6637
Is Sole Proprietor?:No
Enumeration Date:2012-03-21
Last Update Date:2018-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1116621163W00000X
KY3007398367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100199740Medicaid
IN201071890AMedicaid
KYK042540Medicare PIN
IN201071890AMedicaid