MEDICARE: MRS. GINA LEANNE ANDERSON ARNP

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	363L00000X	Nurse Practitioner	Q42098	KS
2	363LF0000X	Family Nurse Practitioner	45682	KS
3	363LF0000X	Family Nurse Practitioner	125117	OK

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P00271606	OTHER	KS	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	925398	OTHER	KS	FIRST GUARD
3	161483	OTHER	KS	BLUE CROSS BLUE SHIELD
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1215952742
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. GINA LEANNE ANDERSON ARNP

Provider Business Mailing Address
First Line	:	3450 E FRANK PHILLIPS BLVD STE 200
Second Line	:
City	:	BARTLESVILLE
State	:	OK
Zip	:	74006-2401
Country	:	US
Telephone Number	:	918-331-2445
Fax Number	:	918-331-2498

Provider Business Practice Location Address
First Line	:	3450 E FRANK PHILLIPS BLVD STE 200
Second Line	:
City	:	BARTLESVILLE
State	:	OK
Zip	:	74006-2401
Country	:	US
Telephone Number	:	918-331-2445
Fax Number	:	918-331-2498

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

Provider Enumeration Date	:	07/13/2006
Last Update Date	:	01/13/2020

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