Basic Information
| Provider Information | |||||||||
| NPI: | 1457373664 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SANDERS | ||||||||
| FirstName: | TERRY | ||||||||
| MiddleName: | GAY | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8300 JO LEE DR | ||||||||
| Address2: | |||||||||
| City: | DENHAM SPRINGS | ||||||||
| State: | LA | ||||||||
| PostalCode: | 707068539 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2259374086 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 5247 DIDESSE DR | ||||||||
| Address2: | |||||||||
| City: | BATON ROUGE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 708089153 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2257653076 | ||||||||
| FaxNumber: | 2257653090 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/24/2006 | ||||||||
| LastUpdateDate: | 02/10/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/10/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | A10174 | LA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
ID Information
| ID | Type | State | Issuer | Description | P00408733 | 01 | LA | RAILROAD MEDICARE | OTHER | 1009733 | 05 | LA | MEDICAID |