Active NPI
Kevin Denard Sanders Sr., CST,CFA
- Surgical Assistant
- Mansfield, TX
National Provider Identifier
1124256946
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgical Assistant
- License
- 109489
- Practice address
- 603 Cross Meadow Blvd
Mansfield, TX 76063-8696 - Phone
- (817) 477-9114
- Fax
- (817) 477-9114
- NPI assigned
- Jul 1, 2009
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgical Assistant | 246ZC0007X | 109489 | TX | Primary |
Addresses
Primary practice location
603 Cross Meadow Blvd
Mansfield, TX 76063-8696
Mailing address
603 Cross Meadow Blvd
Mansfield, TX 76063-8696
Phone (817) 477-9114
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 109489 | TX | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1246406400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1246406400000",
"number": "1124256946",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "603 CROSS MEADOW BLVD",
"city": "MANSFIELD",
"state": "TX",
"postal_code": "760638696",
"telephone_number": "817-477-9114",
"fax_number": "817-477-9114"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "603 CROSS MEADOW BLVD",
"city": "MANSFIELD",
"state": "TX",
"postal_code": "760638696",
"telephone_number": "817-477-9114",
"fax_number": "817-477-9114"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SANDERS",
"first_name": "KEVIN",
"middle_name": "DENARD",
"name_prefix": "Mr.",
"name_suffix": "Sr.",
"credential": "CST,CFA",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2009-07-01",
"last_updated": "2009-07-01",
"status": "A"
},
"taxonomies": [
{
"code": "246ZC0007X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Other, Surgical Assistant",
"state": "TX",
"license": "109489",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Mansfield, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 1, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.