KELLY A ANDERSON NP NPI 1043592033

NPI Information

NPI: 1043592033
Provider Name: KELLY A ANDERSON, NP
Classification: Nurse Practitioner - 363LA2200X
Entity Type: Individual

Specialization: Adult Health

PECOS Registration: Yes

Address:
7900 W JEFFERSON BLVD
SUITE 304
FORT WAYNE, IN
ZIP 46804
Phone: (260) 969-6200
Get Directions

Kelly A Anderson, NP is an adult health nurse practitioner in Fort Wayne, IN with 13 years of experience. Kelly A Anderson, NP NPI is 1043592033. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

7900 W JEFFERSON BLVD
SUITE 304
FORT WAYNE, IN
ZIP 46804-128
Phone: (260) 969-6200
Fax: (260) 969-6201

The NPI 1043592033 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 9/15/2011 and was last updated on 1/13/2012.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	363LA2200X	Nurse Practitioner	Adult Health	71003789A	INDIANA	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	201040960	MEDICAID	INDIANA
2	M400058703	MEDICARE PIN	INDIANA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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