Provider Demographics
NPI:1649316233
Name:SANFORD, DORIS PLUNKETT
Entity type:Individual
Prefix:
First Name:DORIS
Middle Name:PLUNKETT
Last Name:SANFORD
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22741 HIGHWAY 12
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:MS
Mailing Address - Zip Code:39095-3118
Mailing Address - Country:US
Mailing Address - Phone:662-834-1721
Mailing Address - Fax:662-834-1721
Practice Address - Street 1:224 COURT SQ
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:MS
Practice Address - Zip Code:39095-3638
Practice Address - Country:US
Practice Address - Phone:662-834-1721
Practice Address - Fax:662-450-8088
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2025-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR589101363LF0000X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00117094Medicaid
258908OtherRHC PROVIDER NUMBER
MSR589101OtherRN LICENSE NUMBER
MSR589101OtherRN LICENSE NUMBER
MS00117094Medicaid