Healthcare Provider Details

I. General information

NPI: 1427348929
Provider Name (Legal Business Name): JAMES LAMONT ANDERSON PMHNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/18/2011
Last Update Date: 05/26/2020
Certification Date: 05/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4704 HARLAN ST STE 103
WHEAT RIDGE CO
80212-7411
US

IV. Provider business mailing address

308 PALO DURO
ALAMOGORDO NM
88310-8513
US

V. Phone/Fax

Practice location:
  • Phone: 720-310-2773
  • Fax:
Mailing address:
  • Phone: 720-236-6024
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number171197
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number54434
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: