Provider Demographics
NPI:1891786414
Name:HEADRICK, SANDRA K (APRN)
Entity Type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:K
Last Name:HEADRICK
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Gender:F
Credentials:APRN
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Mailing Address - Street 1:1415 W SCENIC RIVERS BLVD
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:MO
Mailing Address - Zip Code:65560-2840
Mailing Address - Country:US
Mailing Address - Phone:573-729-5533
Mailing Address - Fax:573-202-2466
Practice Address - Street 1:600 BLUES LAKE PKWY
Practice Address - Street 2:
Practice Address - City:ROLLA
Practice Address - State:MO
Practice Address - Zip Code:65401-8022
Practice Address - Country:US
Practice Address - Phone:573-364-5719
Practice Address - Fax:573-364-6493
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2022-01-13
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Provider Licenses
StateLicense IDTaxonomies
MO128892363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily