Individual
ALBERT H SANDERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NP-C
Contact information
Practice address
2274 HIGHWAY 43 S, PICAYUNE, MS 39466-8141
(601) 798-3989
(601) 798-3964
Mailing address
2274 HIGHWAY 43 S, PICAYUNE, MS 39466-8141
(601) 798-3989
(601) 798-3964
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
R877250
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
09372043
—
MS
01
—
12123429
CAQH ID NUMBER
MS
05
—
2130145
—
LA
01
—
9260512
AETNA
MS
01
—
P00964914
RAIL ROAD MEDICARE
MS
Enumeration date
05/28/2010
Last updated
02/20/2014
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