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NPI Code Detail

MEDICARE: KRIS D ANDERSON MSW, LCSW

MEDICARE: KRIS D ANDERSON MSW, LCSW
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
11041C0700XClinical Social Worker3065-CAR

General Provider Information

NPI Number : 1811123458
Entity Type Code : Individual
Provider Name (Legal Business Name) : KRIS D ANDERSON MSW, LCSW
Provider Business Mailing Address
First Line : 2400 S 48TH ST
Second Line :
City : SPRINGDALE
State : AR
Zip : 72762-6683
Country : US
Telephone Number : 479-750-2020
Fax Number : 479-750-4843
Provider Business Practice Location Address
First Line : 117 SAWGRASS PT
Second Line :
City : HARRISON
State : AR
Zip : 72601-3072
Country : US
Telephone Number : 870-204-7488
Fax Number : 870-204-5654
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/10/2009
Last Update Date : 09/14/2018

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