Healthcare Provider Details

I. General information

NPI: 1992540595
Provider Name (Legal Business Name): AUSTIN ANDREW ANDERSON DNP-FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/26/2024
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4000 28TH AVE S
MOORHEAD MN
56560-7926
US

IV. Provider business mailing address

PO BOX 5074
SIOUX FALLS SD
57117-5074
US

V. Phone/Fax

Practice location:
  • Phone: 701-234-3200
  • Fax: 701-234-3239
Mailing address:
  • Phone: 605-328-6585
  • Fax: 605-328-6512

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11710
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: