MEDICARE: KIMBERLY LYNN ANDERSON FNP-C

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	17205	CA
2	363LF0000X	Family Nurse Practitioner	30006873	WA
3	363LF0000X	Family Nurse Practitioner	910	AK
4	363LF0000X	Family Nurse Practitioner	AP117527	TX
5	363LF0000X	Family Nurse Practitioner	5009812	NC
6	363LP2300X	Primary Care Nurse Practitioner	AP117527	TX
7	363LF0000X	Family Nurse Practitioner	17205	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	17205	OTHER	CA	CALIFORNIA BON NURSE PRACTITIONER FURNISHER
2	AP30006873	OTHER	WA	WA STATE DEPARTMENT OF HEALTH ARNP LICENSE
3	5009812	OTHER	NC	NC BON AUTHORIZATION TO PRESCRIBE
4	RN00151283	OTHER	WA	WA STATE DOH RN LICENSE
5	12650825	OTHER	AK	CAQH
6	17205	OTHER	CA	CALIFORNIA BON NURSE PRACTITIONER
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
8	5009812	OTHER	NC	NORTH CAROLINA NURSE PRACTITIONER LICENSE
9	9087	OTHER	TX	TEXAS BON RX AUTHORIZATION NUMBER
10	AP117527	OTHER	TX	BON NURSE PRACTITIONER LICENSE

General Provider Information

NPI Number	:	1851308191
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY LYNN ANDERSON FNP-C

Provider Business Mailing Address
First Line	:	3070 SKYWAY DR STE 106
Second Line	:
City	:	SANTA MARIA
State	:	CA
Zip	:	93455-1830
Country	:	US
Telephone Number	:	805-922-8282
Fax Number	:	805-925-2690

Provider Business Practice Location Address
First Line	:	3070 SKYWAY DR STE 106
Second Line	:
City	:	SANTA MARIA
State	:	CA
Zip	:	93455-1830
Country	:	US
Telephone Number	:	805-922-8282
Fax Number	:	844-278-8613

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

Provider Enumeration Date	:	08/01/2006
Last Update Date	:	11/22/2024

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