Healthcare Provider Details

I. General information

NPI: 1811306087
Provider Name (Legal Business Name): LAURA ANDERSON P.A.-C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/12/2014
Last Update Date: 01/21/2026
Certification Date: 01/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 N RACE ST
GLASGOW KY
42141-3454
US

IV. Provider business mailing address

1301 N RACE ST
GLASGOW KY
42141-3454
US

V. Phone/Fax

Practice location:
  • Phone: 270-651-4444
  • Fax: 270-659-3395
Mailing address:
  • Phone: 270-651-4444
  • Fax: 270-659-3395

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA1944
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberTC295
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: