Healthcare Provider Details

I. General information

NPI: 1992147797
Provider Name (Legal Business Name): KERI ANN ANDERSON PA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/22/2013
Last Update Date: 06/06/2025
Certification Date: 06/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 17TH AVE E
ALEXANDRIA MN
56308-5273
US

IV. Provider business mailing address

111 17TH AVE E
ALEXANDRIA MN
56308
US

V. Phone/Fax

Practice location:
  • Phone: 320-762-1511
  • Fax: 320-762-6120
Mailing address:
  • Phone: 320-762-1511
  • Fax: 320-762-6101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number11364
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: