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General NPI Number Information
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NPI Number | 1356940118
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Entity Type | Individual
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Provider Name | JESSICA J ANDERSON AGACNP-BC
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Gender | Female
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Dates
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Enumeration Date | 10/22/2020
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Last Update Date | 02/08/2024
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Provider Practice Location Address
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Address Line | 520 MARY ST STE 520
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City | EVANSVILLE
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State | IN
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Zip | 47710-1682
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Country | US
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Telephone | 812-424-8231
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Fax | 812-435-8794
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Provider Business Mailing Address
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Address Line | 520 MARY ST STE 520
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City | EVANSVILLE
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State | IN
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Zip | 47710-1682
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Country | US
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Telephone | 812-424-8231
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Fax | 812-435-8794
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | 71010855
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License Number State | IN
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