Individual
DEVONA R ANDERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1542 S DIXON RD STE B, KOKOMO, IN 46902-7319
(765) 416-1612
(313) 789-1822
Mailing address
1412 N DELPHOS ST, KOKOMO, IN 46901-2565
(765) 416-1612
(313) 789-1822
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01061169A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11517013
CAQH
—
05
—
200530410
—
IN
Enumeration date
11/07/2005
Last updated
12/17/2024
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