Provider Demographics
NPI:1730263203
Name:SANDERS, JERRY KENT (RNFA)
Entity type:Individual
Prefix:MR
First Name:JERRY
Middle Name:KENT
Last Name:SANDERS
Suffix:
Gender:M
Credentials:RNFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7326 W CHEYENNE AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89129-6201
Mailing Address - Country:US
Mailing Address - Phone:702-499-3828
Mailing Address - Fax:
Practice Address - Street 1:7200 CATHEDRAL ROCK DR
Practice Address - Street 2:SUITE 210
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-0438
Practice Address - Country:US
Practice Address - Phone:702-430-5000
Practice Address - Fax:702-363-9164
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2012-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVRN42954163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant