Provider Demographics
NPI:1306406921
Name:ANDERSON, KITTY RENE (DNP, AGNP-C)
Entity Type:Individual
Prefix:MRS
First Name:KITTY
Middle Name:RENE
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:DNP, AGNP-C
Other - Prefix:
Other - First Name:KITTY
Other - Middle Name:RENE
Other - Last Name:PHIFER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:408 VANCE ST
Mailing Address - Street 2:
Mailing Address - City:ROCKINGHAM
Mailing Address - State:NC
Mailing Address - Zip Code:28379-3459
Mailing Address - Country:US
Mailing Address - Phone:910-334-2080
Mailing Address - Fax:
Practice Address - Street 1:6322 FAYETTEVILLE RD
Practice Address - Street 2:
Practice Address - City:RAEFORD
Practice Address - State:NC
Practice Address - Zip Code:28376-7979
Practice Address - Country:US
Practice Address - Phone:910-878-6721
Practice Address - Fax:910-417-4120
Is Sole Proprietor?:No
Enumeration Date:2019-06-17
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5011877363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner