Provider Demographics
NPI:1770899403
Name:SANDERS, GENNY PATRICIA (APRN)
Entity type:Individual
Prefix:MS
First Name:GENNY
Middle Name:PATRICIA
Last Name:SANDERS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11400 MAIN ST STE 102
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40243-1314
Mailing Address - Country:US
Mailing Address - Phone:502-509-5223
Mailing Address - Fax:814-402-7021
Practice Address - Street 1:11400 MAIN ST STE 102
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40243-1314
Practice Address - Country:US
Practice Address - Phone:502-509-5223
Practice Address - Fax:814-402-7021
Is Sole Proprietor?:No
Enumeration Date:2010-08-18
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3006599363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY3006599OtherLICENSE
KY3006599OtherLICENSE