Provider Demographics
NPI:1285682252
Name:ANDERSON, TERRY A (ARNP)
Entity Type:Individual
Prefix:MS
First Name:TERRY
Middle Name:A
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:555 N WOODLAWN ST STE 102
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67208-3671
Mailing Address - Country:US
Mailing Address - Phone:316-652-2590
Mailing Address - Fax:316-652-2595
Practice Address - Street 1:555 N WOODLAWN ST STE 102
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67208-3671
Practice Address - Country:US
Practice Address - Phone:316-652-2590
Practice Address - Fax:316-652-2595
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2013-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS74492364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200517140CMedicaid
KS200517140CMedicaid