Healthcare Provider Details

I. General information

NPI: 1326932542
Provider Name (Legal Business Name): TAYLOR ANDERSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/03/2025
Last Update Date: 06/03/2025
Certification Date: 06/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 CENTER AVE STE 105
KODIAK AK
99615-6393
US

IV. Provider business mailing address

529 CARROLL WAY APT B8
KODIAK AK
99615-6999
US

V. Phone/Fax

Practice location:
  • Phone: 907-942-9222
  • Fax:
Mailing address:
  • Phone: 907-942-9222
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: