Provider Demographics
NPI:1558667683
Name:ANNETTE N. ANDERSON, MD, PA
Entity Type:Organization
Organization Name:ANNETTE N. ANDERSON, MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANNETTE
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:501-227-8311
Mailing Address - Street 1:14008 WINDSOR RD
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72212-3201
Mailing Address - Country:US
Mailing Address - Phone:501-227-8311
Mailing Address - Fax:501-227-8311
Practice Address - Street 1:2425 DAVE WARD DR
Practice Address - Street 2:SUITE 102
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72034-8686
Practice Address - Country:US
Practice Address - Phone:501-932-0480
Practice Address - Fax:501-932-0106
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-08
Last Update Date:2011-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric PsychiatryGroup - Single Specialty