1851308191 NPI number — KIMBERLY LYNN ANDERSON FNP-C

Table of content: KIMBERLY LYNN ANDERSON FNP-C (NPI 1851308191)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851308191 NPI number — KIMBERLY LYNN ANDERSON FNP-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ANDERSON
Provider First Name:
KIMBERLY
Provider Middle Name:
LYNN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
FNP-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1851308191
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
237 TOWN CTR W # 237
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SANTA MARIA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93458-5075
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
907-351-2907
Provider Business Mailing Address Fax Number:
844-278-8613

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 E NORTH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TAFT
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93268
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-765-1935
Provider Business Practice Location Address Fax Number:
661-765-1928
Provider Enumeration Date:
08/01/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  5009812 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X , with the licence number: 30006873 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X , with the licence number: 910 , registered in the state of AK ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X , with the licence number: AP117527 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LP2300X , with the licence number: AP117527 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X , with the licence number: 17205 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 9087 . This is a "TEXAS BON RX AUTHORIZATION NUMBER" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 12650825 . This is a "CAQH" identifier , issued by the state of ( AK ) . This identifiers is of the category "OTHER".
  • Identifier: 17205 . This is a "CALIFORNIA BON NURSE PRACTITIONER" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 5009812 . This is a "NC BON AUTHORIZATION TO PRESCRIBE" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: RN00151283 . This is a "WA STATE DOH RN LICENSE" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: AP30006873 . This is a "WA STATE DEPARTMENT OF HEALTH ARNP LICENSE" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 17205 . This is a "CALIFORNIA BON NURSE PRACTITIONER FURNISHER" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 1023099 , issued by the state of ( AK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5009812 . This is a "NORTH CAROLINA NURSE PRACTITIONER LICENSE" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: AP117527 . This is a "BON NURSE PRACTITIONER LICENSE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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