MEDICARE: MICHAEL R ANDERSON RN, 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
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	APN.1001330-NP	CO
2	163W00000X	Registered Nurse	6685217-3102	UT
3	164W00000X	Licensed Practical Nurse	6685217-3101	UT
4	247200000X	Other Technician
5	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	6685217-4405	UT

General Provider Information

NPI Number	:	1295992097
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL R ANDERSON RN, APRN

Provider Business Mailing Address
First Line	:	474 W 200 N
Second Line	:	STE#300
City	:	ST GEORGE
State	:	UT
Zip	:	84770-4505
Country	:	US
Telephone Number	:	435-634-5600
Fax Number	:	435-986-8700

Provider Business Practice Location Address
First Line	:	6650 S VINE ST STE 100
Second Line	:
City	:	CENTENNIAL
State	:	CO
Zip	:	80121-2740
Country	:	US
Telephone Number	:	303-535-7548
Fax Number	:

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

Provider Enumeration Date	:	05/20/2008
Last Update Date	:	12/08/2025

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