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General NPI Number Information
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NPI Number | 1942939079
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Entity Type | Individual
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Provider Name | KYLE S. ANDERSON DO
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Gender | Male
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Dates
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Enumeration Date | 06/06/2022
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Last Update Date | 07/21/2025
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Provider Practice Location Address
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Address Line | 3801 50TH ST
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City | LUBBOCK
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State | TX
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Zip | 79413-3807
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Country | US
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Telephone | 806-725-8500
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Fax | 806-725-7701
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Provider Business Mailing Address
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Address Line | 2215 NASHVILLE AVE
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City | LUBBOCK
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State | TX
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Zip | 79410-1105
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Country | US
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Telephone | 806-725-5228
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Fax | 806-723-6532
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number | OL61299767
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | V7436
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License Number State | TX
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