Individual
KELLY A ANDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
7900 W JEFFERSON BLVD, SUITE 304, FORT WAYNE, IN 46804-4128
(260) 969-6200
(260) 969-6201
Mailing address
PO BOX 8857, FORT WAYNE, IN 46898-8857
(260) 969-6200
(260) 969-6201
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
71003789A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201040960
—
IN
Enumeration date
09/15/2011
Last updated
01/13/2012
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