Healthcare Provider Details

I. General information

NPI: 1275246522
Provider Name (Legal Business Name): KRISTEN HOLLY ANDERSON FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/02/2023
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10939 AL HIGHWAY 157
MOULTON AL
35650-1914
US

IV. Provider business mailing address

19575 COUNTY ROAD 460
MOULTON AL
35650-7341
US

V. Phone/Fax

Practice location:
  • Phone: 256-974-6550
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1-173427
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: