Healthcare Provider Details

I. General information

NPI: 1720054182
Provider Name (Legal Business Name): REBECCA A ANDERSON P.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2006
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3405 NW HUNTERS RIDGE TER
TOPEKA KS
66618-2509
US

IV. Provider business mailing address

4921 W 18TH ST
LAWRENCE KS
66047-2090
US

V. Phone/Fax

Practice location:
  • Phone: 785-295-5325
  • Fax: 785-295-5334
Mailing address:
  • Phone: 785-830-0100
  • Fax: 785-830-0115

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number15-00320
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: