Provider Demographics
NPI:1205996758
Name:SANDERS, MARTHA (APN)
Entity type:Individual
Prefix:MRS
First Name:MARTHA
Middle Name:
Last Name:SANDERS
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 497
Mailing Address - Street 2:623 N 9TH STREET
Mailing Address - City:AUGUSTA
Mailing Address - State:AR
Mailing Address - Zip Code:72006
Mailing Address - Country:US
Mailing Address - Phone:870-347-3300
Mailing Address - Fax:870-347-3492
Practice Address - Street 1:125 OAK ST
Practice Address - Street 2:
Practice Address - City:COTTON PLANT
Practice Address - State:AR
Practice Address - Zip Code:72036-5089
Practice Address - Country:US
Practice Address - Phone:870-459-3588
Practice Address - Fax:870-459-3906
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2016-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA01500363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR165030758Medicaid
AR57297Medicare PIN
AR5A378Medicare PIN
AR165030758Medicaid