Healthcare Provider Details

I. General information

NPI: 1992685432
Provider Name (Legal Business Name): MATTHEW STEVEN ANDERSON RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/04/2025
Last Update Date: 09/04/2025
Certification Date: 09/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

456 MOHICAN LN
SHREVEPORT LA
71106-8317
US

IV. Provider business mailing address

456 MOHICAN LN
SHREVEPORT LA
71106-8317
US

V. Phone/Fax

Practice location:
  • Phone: 318-294-7382
  • Fax:
Mailing address:
  • Phone: 318-294-7382
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TP0016X
TaxonomyPrescribing (Medical) Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: