Individual
TYLER LEE SANDERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
620 E MONROE ST, MEXICO, MO 65265-2919
(660) 728-0061
Mailing address
PO BOX 843966, KANSAS CITY, MO 64184-3966
(573) 884-3300
(573) 884-0943
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
2021010812
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
220099242
—
MO
Enumeration date
05/21/2021
Last updated
11/21/2022
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