Provider Demographics
NPI:1275764755
Name:ANDERSON, KANDESS J (CRNP)
Entity Type:Individual
Prefix:MRS
First Name:KANDESS
Middle Name:J
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:KANDESS
Other - Middle Name:RUTH
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 2705
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35804-2705
Mailing Address - Country:US
Mailing Address - Phone:256-265-1910
Mailing Address - Fax:256-265-1911
Practice Address - Street 1:201 SIVLEY ROAD
Practice Address - Street 2:SUITE 330
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-5177
Practice Address - Country:US
Practice Address - Phone:256-265-1910
Practice Address - Fax:256-265-1911
Is Sole Proprietor?:No
Enumeration Date:2009-08-02
Last Update Date:2011-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-103807363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily