=====================================================
General NPI Number Information
=====================================================
NPI Number | 1487591947
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KENYADA ANDERSON LVN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/01/2026
-----------------------------------------------------
Last Update Date | 05/01/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4177 GAZEBO ST APT 6309
-----------------------------------------------------
City | AUBREY
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76227-4550
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 469-956-9968
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4177 GAZEBO ST APT 6309
-----------------------------------------------------
City | AUBREY
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76227-4550
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 469-956-9968
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 164X00000X
-----------------------------------------------------
Taxonomy Name | Licensed Vocational Nurse
-----------------------------------------------------
License Number | 1014645
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------