MEDICARE: MICHEL ANDERSON FNP

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	363L00000X	Nurse Practitioner	2016018333	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1174973879
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHEL ANDERSON FNP

Provider Business Mailing Address
First Line	:	PO BOX 505164
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63150-5164
Country	:	US
Telephone Number	:	417-829-4620
Fax Number	:

Provider Business Practice Location Address
First Line	:	1422 S SAM HOUSTON BLVD
Second Line	:
City	:	HOUSTON
State	:	MO
Zip	:	65483-2130
Country	:	US
Telephone Number	:	417-967-4445
Fax Number	:

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

Provider Enumeration Date	:	06/14/2016
Last Update Date	:	09/25/2024

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