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NPI Code Detail

MEDICARE: MR. KENDALL ANDERSON

MEDICARE: MR. KENDALL 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
1101Y00000XCounselor

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
101OTHEREMPLOYER

General Provider Information

NPI Number : 1154052967
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. KENDALL ANDERSON
Provider Business Mailing Address
First Line : 159 LORAINE RD
Second Line :
City : MEMPHIS
State : TN
Zip : 38109-8513
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3720 ALUMNI AVE
Second Line :
City : MEMPHIS
State : TN
Zip : 38111-5914
Country : US
Telephone Number : 901-678-2000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/22/2022
Last Update Date : 06/22/2022

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Directions to “ MR. KENDALL ANDERSON ” Practice Location

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