Healthcare Provider Details

I. General information

NPI: 1447632351
Provider Name (Legal Business Name): KRISTIE ANDERSON CFNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2015
Last Update Date: 04/23/2025
Certification Date: 04/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

805 E RIVER PL
JACKSON MS
39202-3486
US

IV. Provider business mailing address

805 E RIVER PL
JACKSON MS
39202-3486
US

V. Phone/Fax

Practice location:
  • Phone: 601-500-7660
  • Fax: 769-243-7946
Mailing address:
  • Phone: 601-500-7660
  • Fax: 769-243-7946

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR883183
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: