Healthcare Provider Details

I. General information

NPI: 1073569224
Provider Name (Legal Business Name): KENNETH ALLEN ANDERSON PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2006
Last Update Date: 02/11/2026
Certification Date: 02/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2874 S NC 127 HWY
HICKORY NC
28602-9131
US

IV. Provider business mailing address

2874 S NC 127 HWY
HICKORY NC
28602-9131
US

V. Phone/Fax

Practice location:
  • Phone: 828-294-4100
  • Fax: 800-951-8614
Mailing address:
  • Phone: 828-294-4100
  • Fax: 800-951-8614

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0010-00519
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: