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NPI Code Detail

MEDICARE: KELLY MARIE ANDERSON APRN

MEDICARE: KELLY MARIE ANDERSON APRN
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
1163W00000XRegistered Nurse28216712AIN
2363LF0000XFamily Nurse Practitioner71010494AIN

General Provider Information

NPI Number : 1184255408
Entity Type Code : Individual
Provider Name (Legal Business Name) : KELLY MARIE ANDERSON APRN
Provider Business Mailing Address
First Line : PO BOX 775383
Second Line :
City : CHICAGO
State : IL
Zip : 60677-5383
Country : US
Telephone Number : 812-376-3515
Fax Number :
Provider Business Practice Location Address
First Line : 3015 10TH ST STE A
Second Line :
City : COLUMBUS
State : IN
Zip : 47201-7091
Country : US
Telephone Number : 812-372-8883
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/27/2020
Last Update Date : 03/26/2026

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