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NPI Code Detail

MEDICARE: DR. JENNIFER LYNN ANDERSON MD

MEDICARE: DR. JENNIFER LYNN ANDERSON MD
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
1207V00000XObstetrics & Gynecology PhysicianE7731AR
2207V00000XObstetrics & Gynecology PhysicianA75325CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2262469837OTHERCABLUE CROSS
3262469837OTHERCABLUE SHIELD

General Provider Information

NPI Number : 1467489203
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JENNIFER LYNN ANDERSON MD
Provider Business Mailing Address
First Line : 1 LILE CT STE 200
Second Line :
City : LITTLE ROCK
State : AR
Zip : 72205-6240
Country : US
Telephone Number : 501-224-5500
Fax Number : 501-224-1166
Provider Business Practice Location Address
First Line : 1 LILE CT STE 200
Second Line :
City : LITTLE ROCK
State : AR
Zip : 72205-6240
Country : US
Telephone Number : 501-224-5500
Fax Number : 501-224-1166
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/27/2006
Last Update Date : 11/19/2013

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Directions to “ DR. JENNIFER LYNN ANDERSON MD” Practice Location

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