Healthcare Provider Details

I. General information

NPI: 1487481842
Provider Name (Legal Business Name): AUSTIN LANE ANDERSON FNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/18/2024
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

475 N HIGHWAY 25 W
WILLIAMSBURG KY
40769-1576
US

IV. Provider business mailing address

6178 COLLEGE STATION DR
WILLIAMSBURG KY
40769-1372
US

V. Phone/Fax

Practice location:
  • Phone: 606-549-2930
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4027886
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: