Provider Demographics
NPI:1013227982
Name:ANDERSON, KIMBERLI ANN
Entity Type:Individual
Prefix:
First Name:KIMBERLI
Middle Name:ANN
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:773 N 2770 W
Mailing Address - Street 2:
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84601-1185
Mailing Address - Country:US
Mailing Address - Phone:801-734-0168
Mailing Address - Fax:
Practice Address - Street 1:1358 W BUSINESS PARK DR
Practice Address - Street 2:
Practice Address - City:OREM
Practice Address - State:UT
Practice Address - Zip Code:84058-2203
Practice Address - Country:US
Practice Address - Phone:801-373-1197
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-13
Last Update Date:2010-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker