| Doctor Name: | MS. SANDRA D MCKISSON |
| NPI Number: | 1073742979 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | APN |
| License Number: | A03188ANP |
| Business Practice Address: | 1306 N Center St Lonoke, AR - 720862011 |
| Business Phone Number: | 5016766560 |
| Business Fax Number: | 5016767166 |
| Mailing Address: | 1306 N Center St, LONOKE |
| State: | AR |
| Postal Code: | 720862011 |
| Phone Number: | 5016766560 |
| Fax Number: | 5016767166 |
| NPI Enumeration Date: | 07/13/2009 |
| NPI Last Update Date: | 11/23/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LA2100X |
| License Number: | A03188ANP |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | AR |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Acute Care |
| Taxonomy Definition: | |