Provider Demographics
NPI:1477247112
Name:ANDERSON, AUDREY MARIA (MSN, APRN, FNP)
Entity Type:Individual
Prefix:MRS
First Name:AUDREY
Middle Name:MARIA
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:MSN, APRN, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1017 RUSSELL ST
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:VA
Mailing Address - Zip Code:24201-4450
Mailing Address - Country:US
Mailing Address - Phone:276-791-9170
Mailing Address - Fax:
Practice Address - Street 1:403 CHILHOWIE ST
Practice Address - Street 2:
Practice Address - City:CHILHOWIE
Practice Address - State:VA
Practice Address - Zip Code:24319-3461
Practice Address - Country:US
Practice Address - Phone:276-646-3241
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-06
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024186914363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily