Individual
MARY ELLEN ANDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
1201 PLEASANT VALLEY RD, OWENSBORO, KY 42303-9811
(270) 417-5911
(270) 417-6497
Mailing address
104 RAINTREE PL, GLASGOW, KY 42141-2244
(818) 462-0990
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
4690P
KY
363LF0000X
Family Nurse Practitioner
Primary
3004690
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000845568
ANTHEM
KY
05
—
7100235010
—
KY
01
—
P01351973
RR MEDICARE
KY
Enumeration date
09/22/2006
Last updated
09/09/2022
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