Provider Demographics
NPI:1578566659
Name:ANDERSON, DEBORAH (APRN)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 MORTON BLVD
Mailing Address - Street 2:
Mailing Address - City:HAZARD
Mailing Address - State:KY
Mailing Address - Zip Code:41701-9418
Mailing Address - Country:US
Mailing Address - Phone:606-436-0514
Mailing Address - Fax:606-436-0770
Practice Address - Street 1:305 MORTON BLVD
Practice Address - Street 2:
Practice Address - City:HAZARD
Practice Address - State:KY
Practice Address - Zip Code:41701-9418
Practice Address - Country:US
Practice Address - Phone:606-436-0514
Practice Address - Fax:606-436-0770
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2023-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3003127363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY78003654Medicaid
KY78003654Medicaid
KY1371416Medicare PIN