Provider Demographics
NPI:1073163887
Name:ANDERSYN MEDICAL ASSOCIATES, PLLC
Entity Type:Organization
Organization Name:ANDERSYN MEDICAL ASSOCIATES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KASEY
Authorized Official - Middle Name:
Authorized Official - Last Name:SUTTERFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:APN, FNP
Authorized Official - Phone:501-658-6253
Mailing Address - Street 1:65 IONA WAY
Mailing Address - Street 2:
Mailing Address - City:BATESVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72501-4224
Mailing Address - Country:US
Mailing Address - Phone:501-658-6253
Mailing Address - Fax:
Practice Address - Street 1:65 IONA WAY
Practice Address - Street 2:
Practice Address - City:BATESVILLE
Practice Address - State:AR
Practice Address - Zip Code:72501-4224
Practice Address - Country:US
Practice Address - Phone:501-658-6253
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-13
Last Update Date:2020-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care