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NPI Code Detail

MEDICARE: KIMBERLY ANN ANDERSON

MEDICARE: KIMBERLY ANN 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
1390200000XStudent in an Organized Health Care Education/Training Program2482161MN

General Provider Information

NPI Number : 1063365609
Entity Type Code : Individual
Provider Name (Legal Business Name) : KIMBERLY ANN ANDERSON
Provider Business Mailing Address
First Line : 325 S LAKE AVE STE 604
Second Line :
City : DULUTH
State : MN
Zip : 55802-2364
Country : US
Telephone Number : 605-323-7672
Fax Number :
Provider Business Practice Location Address
First Line : 1200 KENWOOD AVE
Second Line :
City : DULUTH
State : MN
Zip : 55811-4199
Country : US
Telephone Number : 218-625-4408
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/16/2026
Last Update Date : 02/16/2026

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Directions to “ KIMBERLY ANN ANDERSON ” Practice Location

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