Provider Demographics
NPI:1780186908
Name:ANDERSON, GREGORY ALAN (DNP, FNP-C)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:ALAN
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:DNP, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5346 BIRCH ST
Mailing Address - Street 2:
Mailing Address - City:ROELAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66205-2148
Mailing Address - Country:US
Mailing Address - Phone:913-579-2662
Mailing Address - Fax:
Practice Address - Street 1:13045 S MUR LEN RD
Practice Address - Street 2:
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66062-1230
Practice Address - Country:US
Practice Address - Phone:913-782-2974
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-03
Last Update Date:2018-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2018004093363LF0000X
KS53-78057-051363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily