Individual
SANDRA FAYE STENNETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PAC
Contact information
Practice address
1532 BRIDGE RD APT A, CHARLESTON, WV 25314-1900
(304) 541-7763
Mailing address
1532 BRIDGE RD APT A, CHARLESTON, WV 25314-1900
(304) 541-7763
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
PA895
KY
363AM0700X
Medical Physician Assistant
Primary
01204
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
001906149
MS BCBS
WV
05
—
3810006840
—
WV
05
—
95005708
—
KY
Enumeration date
02/27/2006
Last updated
02/17/2010
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