Individual
DR. KELLY R ANDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
520 S 7TH ST, VINCENNES, IN 47591-1038
(812) 885-3810
(812) 885-3811
Mailing address
520 S 7TH ST, VINCENNES, IN 47591-1038
(812) 885-3685
(812) 885-3917
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
02001311A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000110680
ANTHEM
IN
05
—
200022500
—
IN
Enumeration date
09/23/2005
Last updated
04/20/2018
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