MEDICARE: DR. AMY KATHRYN ANDERSON M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2080P0206X	Pediatric Gastroenterology Physician	15660	NE
2	2084P0804X	Child & Adolescent Psychiatry Physician	15660	NE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	15660	OTHER	NE	STATE LICENSE

General Provider Information

NPI Number	:	1144310277
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AMY KATHRYN ANDERSON M.D.

Provider Business Mailing Address
First Line	:	715 N SAINT JOSEPH AVE
Second Line	:
City	:	HASTINGS
State	:	NE
Zip	:	68901-4451
Country	:	US
Telephone Number	:	402-460-5836
Fax Number	:	402-460-5829

Provider Business Practice Location Address
First Line	:	835 S BURLINGTON AVE
Second Line	:	SUITE 108
City	:	HASTINGS
State	:	NE
Zip	:	68901-6928
Country	:	US
Telephone Number	:	402-463-7711
Fax Number	:	402-461-5099

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/12/2006
Last Update Date	:	03/07/2023

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