Provider Demographics
NPI:1902392871
Name:SANDERS, JEREMIAH R (APRN, PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:JEREMIAH
Middle Name:R
Last Name:SANDERS
Suffix:
Gender:M
Credentials:APRN, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2010 GILMER RD STE 103B
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75604-2545
Mailing Address - Country:US
Mailing Address - Phone:903-213-9120
Mailing Address - Fax:
Practice Address - Street 1:2010 GILMER RD STE 103B
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75604-2545
Practice Address - Country:US
Practice Address - Phone:903-213-9120
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-03
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP137913363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health