Healthcare Provider Details

I. General information

NPI: 1841387792
Provider Name (Legal Business Name): JANE M ANDERSON RN ARNP CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 06/28/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

214 BOGGS LANE
RICHMOND KY
40475
US

IV. Provider business mailing address

2124 LEAFLAUND PLACE 2
LEXINGTON KY
40515
US

V. Phone/Fax

Practice location:
  • Phone: 859-623-7312
  • Fax: 859-626-4298
Mailing address:
  • Phone: 859-273-9714
  • Fax: 859-626-4298

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number1038366
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number771M
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: