Provider Demographics
NPI:1134342504
Name:SANDERS, KIERSTEN LYNN (BS ELEMENTARY EDUCAT)
Entity type:Individual
Prefix:
First Name:KIERSTEN
Middle Name:LYNN
Last Name:SANDERS
Suffix:
Gender:F
Credentials:BS ELEMENTARY EDUCAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3778 W COUNTY ROAD 400 S
Mailing Address - Street 2:
Mailing Address - City:KOKOMO
Mailing Address - State:IN
Mailing Address - Zip Code:46902-9115
Mailing Address - Country:US
Mailing Address - Phone:765-432-2804
Mailing Address - Fax:765-883-8193
Practice Address - Street 1:3778 W COUNTY ROAD 400 S
Practice Address - Street 2:
Practice Address - City:KOKOMO
Practice Address - State:IN
Practice Address - Zip Code:46902-9115
Practice Address - Country:US
Practice Address - Phone:765-432-2804
Practice Address - Fax:765-883-8193
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN747145373H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist