Provider Demographics
NPI:1902861578
Name:SANDERS, KIMBERLY JO (DO)
Entity Type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:JO
Last Name:SANDERS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8100 EWING BLVD
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:KY
Mailing Address - Zip Code:41042-7588
Mailing Address - Country:US
Mailing Address - Phone:859-647-8725
Mailing Address - Fax:859-647-8726
Practice Address - Street 1:8100 EWING BLVD
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:KY
Practice Address - Zip Code:41042-7588
Practice Address - Country:US
Practice Address - Phone:859-647-8725
Practice Address - Fax:859-647-8726
Is Sole Proprietor?:No
Enumeration Date:2006-04-18
Last Update Date:2017-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY02742207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY080185147OtherRAILROAD MEDICARE
OH2212804Medicaid
KY64049695Medicaid
KY0364951Medicare PIN
KYH21790Medicare UPIN