Active NPI
Kristin M Sanderson, M.D.
- Specialist
- Las Vegas, NV
National Provider Identifier
1700938354
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- License
- 12266
- Practice address
- 5701 W Charleston Blvd
Suite 201
Las Vegas, NV 89146-1217 - Phone
- (702) 877-0814
- Fax
- (702) 877-0113
- NPI assigned
- Jan 16, 2007
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Specialist | 174400000X | 12266 | NV | Primary |
Addresses
Primary practice location
5701 W Charleston Blvd
Suite 201
Las Vegas, NV 89146-1217
Mailing address
5701 W Charleston Blvd
Suite 201
Las Vegas, NV 89146-1217
Phone (702) 877-0814
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 100512506 | Medicaid | NV |
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)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 12266 | NV | MD | Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1168905600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1208476800000",
"number": "1700938354",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5701 W CHARLESTON BLVD",
"address_2": "SUITE 201",
"city": "LAS VEGAS",
"state": "NV",
"postal_code": "891461217",
"telephone_number": "702-877-0814",
"fax_number": "702-877-0113"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5701 W CHARLESTON BLVD",
"address_2": "SUITE 201",
"city": "LAS VEGAS",
"state": "NV",
"postal_code": "891461217",
"telephone_number": "702-877-0814",
"fax_number": "702-877-0113"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SANDERSON",
"first_name": "KRISTIN",
"middle_name": "M",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-01-16",
"last_updated": "2008-04-18",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "NV",
"license": "12266",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "100512506",
"state": "NV"
}
],
"endpoints": [],
"other_names": []
}Other providers in Las Vegas, NV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 18, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.