Individual
KENNETH B ANDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1935 W MAIN ST, SALEM, VA 24153-3109
(540) 387-0441
(540) 389-7868
Mailing address
213 S JEFFERSON ST STE 1006, ROANOKE, VA 24011-1713
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
0110840603
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
008932395
—
VA
01
—
0110840603
STATE LICENSE
VA
Enumeration date
08/15/2006
Last updated
03/15/2024
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