Provider Demographics
NPI:1891195459
Name:ANDERSON, KRISTEN (AGNP-BC)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:AGNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1015 2ND ST NE APT 110
Mailing Address - Street 2:
Mailing Address - City:HOPKINS
Mailing Address - State:MN
Mailing Address - Zip Code:55343-8342
Mailing Address - Country:US
Mailing Address - Phone:218-256-1671
Mailing Address - Fax:
Practice Address - Street 1:1015 2ND ST NE APT 110
Practice Address - Street 2:
Practice Address - City:HOPKINS
Practice Address - State:MN
Practice Address - Zip Code:55343-8342
Practice Address - Country:US
Practice Address - Phone:218-256-1671
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-01
Last Update Date:2014-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR 202784-5363LA2200X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology