Provider Demographics
NPI:1235808338
Name:ANDERSON, KAYLEIGH (APRN)
Entity Type:Individual
Prefix:
First Name:KAYLEIGH
Middle Name:
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 12
Mailing Address - Street 2:
Mailing Address - City:LIBERTY LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:99019-0012
Mailing Address - Country:US
Mailing Address - Phone:406-327-3057
Mailing Address - Fax:406-327-3231
Practice Address - Street 1:1211 S RESERVE ST STE 101
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59801-3103
Practice Address - Country:US
Practice Address - Phone:406-327-3057
Practice Address - Fax:406-327-3231
Is Sole Proprietor?:No
Enumeration Date:2021-09-10
Last Update Date:2021-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTNUR-RN-LIC-49168163W00000X
MTNUR-APRN-LIC-177433363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse