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NPI Code Detail

MEDICARE: DR. KIMBERLY ANDERSON PSY.D., LP

MEDICARE: DR. KIMBERLY ANDERSON PSY.D., LP
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
1103TC0700XClinical Psychologist6495MN

General Provider Information

NPI Number : 1891249140
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. KIMBERLY ANDERSON PSY.D., LP
Provider Business Mailing Address
First Line : 1403 SILVER LAKE RD NW STE 2
Second Line :
City : NEW BRIGHTON
State : MN
Zip : 55112-9308
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1403 SILVER LAKE RD NW STE 2
Second Line :
City : NEW BRIGHTON
State : MN
Zip : 55112-9308
Country : US
Telephone Number : 651-895-3624
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/03/2016
Last Update Date : 06/27/2025

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