Individual
KENNETH MICHAEL SANDERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
923 E CENTRAL AVE, LA FOLLETTE, TN 37766-2768
(423) 907-1200
(865) 291-3228
Mailing address
226 COVE POINTE RD, LA FOLLETTE, TN 37766-5945
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
000443
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4108109
BCBS
TN
01
—
P00310586
MEDICARE RAILROAD
TN
Enumeration date
06/05/2006
Last updated
12/04/2007
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