Healthcare Provider Details

I. General information

NPI: 1093634214
Provider Name (Legal Business Name): ANDERSON AESTHETICS AND RECONSTRUCTIVE SURGERY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2026
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1802 ROCKINGHAM AVE
BOWLING GREEN KY
42104-3348
US

IV. Provider business mailing address

1802 ROCKINGHAM AVE
BOWLING GREEN KY
42104-3348
US

V. Phone/Fax

Practice location:
  • Phone: 270-407-1334
  • Fax:
Mailing address:
  • Phone: 270-407-1334
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: WILLIAM ANDERSON
Title or Position: OWNER
Credential: MD
Phone: 270-407-1334