Provider Demographics
NPI:1689922056
Name:ANDERSON, LAUREN BROOKE (PA-C)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:BROOKE
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:181 POWELL VALLEY SCHOOL LN
Mailing Address - Street 2:
Mailing Address - City:SPEEDWELL
Mailing Address - State:TN
Mailing Address - Zip Code:37870-7431
Mailing Address - Country:US
Mailing Address - Phone:423-419-5070
Mailing Address - Fax:423-869-0081
Practice Address - Street 1:181 POWELL VALLEY SCHOOL LN
Practice Address - Street 2:
Practice Address - City:SPEEDWELL
Practice Address - State:TN
Practice Address - Zip Code:37870-7431
Practice Address - Country:US
Practice Address - Phone:423-419-5070
Practice Address - Fax:423-869-0081
Is Sole Proprietor?:No
Enumeration Date:2012-08-16
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN99056427A363A00000X
IN10001514A363A00000X
TN2028363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN1487680518OtherGROUP NPI
IN000000340608OtherANTHEM
TN1629330923OtherGROUP NPI