Provider Demographics
NPI:1346413887
Name:ANDERSON, KELLIE LYNN
Entity Type:Individual
Prefix:MRS
First Name:KELLIE
Middle Name:LYNN
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 N CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:BELOIT
Mailing Address - State:KS
Mailing Address - Zip Code:67420-2742
Mailing Address - Country:US
Mailing Address - Phone:316-323-7460
Mailing Address - Fax:
Practice Address - Street 1:118 N CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:BELOIT
Practice Address - State:KS
Practice Address - Zip Code:67420-2742
Practice Address - Country:US
Practice Address - Phone:316-323-7460
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-04
Last Update Date:2008-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator