Healthcare Provider Details

I. General information

NPI: 1811170301
Provider Name (Legal Business Name): ANNETTE N. ANDERSON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/07/2007
Last Update Date: 02/05/2025
Certification Date: 02/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 ADA AVE STE 302A
CONWAY AR
72034-4985
US

IV. Provider business mailing address

PO BOX 9662
CONWAY AR
72033-9662
US

V. Phone/Fax

Practice location:
  • Phone: 501-932-0352
  • Fax: 501-932-0354
Mailing address:
  • Phone: 501-358-6695
  • Fax: 501-358-6860

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License NumberE-5622
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: