Provider Demographics
NPI:1952359507
Name:SANDERS, BILLY DON (CRNA , MSN)
Entity type:Individual
Prefix:MR
First Name:BILLY
Middle Name:DON
Last Name:SANDERS
Suffix:
Gender:M
Credentials:CRNA , MSN
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 771522
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38177-1522
Mailing Address - Country:US
Mailing Address - Phone:479-200-4933
Mailing Address - Fax:901-261-2542
Practice Address - Street 1:1601 NEWCASTLE ROAD
Practice Address - Street 2:
Practice Address - City:FORREST CITY
Practice Address - State:AR
Practice Address - Zip Code:72335-2218
Practice Address - Country:US
Practice Address - Phone:870-261-0000
Practice Address - Fax:870-261-0405
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2010-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC01199367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR141503701Medicaid
AR5U555OtherBLUE CROSS AR PROVIDER #
AR5U555Medicare ID - Type UnspecifiedAR MEDICARE PROVIDER #