Anderson, Kelly D

Anderson, Kelly D is an individual health care provider with primary practice located at 1025 N Country Club Dr , Mesa AZ 85201-3307. She recently has only one registered license in Behavioral Health & Social Service Providers / School, which is considered as her primary health care specialty. Anderson, Kelly D can be contacted via phone (480) 472-0502.

Contact Information

Primary practice address
1025 N Country Club Dr Mesa AZ 85201-3307
Phone: (480) 472-0502
Fax: (480) 472-0705
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / School 103TS0200X

Profile Details

NPI number 1578685996
LBN Legal business name Anderson, Kelly D
Credentials
Entity Individual
Sole proprietor 1 No
Enumeration date Apr 5th, 2007
Last updated Jul 9th, 2007 - about 17 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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1578685996 NPPES
Arizona MEDICAID 590928

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