Anderson, Kelly A
Anderson, Kelly A is an individual health care provider with primary practice located at 7900 W Jefferson Blvd Suite 304, Fort Wayne IN 46804-4128. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Adult Health, which is considered as her primary health care specialty. Anderson, Kelly A can be contacted via phone (260) 969-6200.Contact Information
Primary practice address
7900 W Jefferson Blvd Suite 304
Fort Wayne IN 46804-4128
Phone: (260) 969-6200
Fax: (260) 969-6201
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Physician Assistants & Advanced Practice Nursing Providers / Adult Health | 363LA2200X | 71003789A | Indiana |
Profile Details
| NPI number | 1043592033 |
|---|---|
| LBN Legal business name | Anderson, Kelly A |
| Credentials | Nurse Practitioner (NP) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Sep 15th, 2011 |
| Last updated | Jan 13th, 2012 - about 13 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1043592033 | NPPES |
| Indiana | MEDICAID | 201040960 |
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