Provider Demographics
NPI:1053068320
Name:ANDERSON, KIANNA (MSN, APRN, FNP-BC)
Entity Type:Individual
Prefix:
First Name:KIANNA
Middle Name:
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:MSN, APRN, FNP-BC
Other - Prefix:
Other - First Name:KIANNA
Other - Middle Name:
Other - Last Name:WHITTINGTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:17743 NORTHROP ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48219-2321
Mailing Address - Country:US
Mailing Address - Phone:313-932-0146
Mailing Address - Fax:
Practice Address - Street 1:17743 NORTHROP ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48219-2321
Practice Address - Country:US
Practice Address - Phone:313-932-0146
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-07
Last Update Date:2022-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704312785363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty