MEDICARE: CRYSTAL DAWN ANDERSON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	20221006600	MO

General Provider Information

NPI Number	:	1033084322
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CRYSTAL DAWN ANDERSON

Provider Business Mailing Address
First Line	:	11900 N CHARLOTTE ST
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64155-1096
Country	:	US
Telephone Number	:	816-404-1500
Fax Number	:

Provider Business Practice Location Address
First Line	:	11900 N CHARLOTTE ST
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64155-1096
Country	:	US
Telephone Number	:	816-404-1500
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/07/2025
Last Update Date	:	10/24/2025

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