Provider Demographics
NPI:1942936760
Name:ANDERSON, JAMES HAROLD
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:HAROLD
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4209 NICKLAUS AVE
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-5873
Mailing Address - Country:US
Mailing Address - Phone:972-922-9821
Mailing Address - Fax:
Practice Address - Street 1:4209 NICKLAUS AVE
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-5873
Practice Address - Country:US
Practice Address - Phone:972-922-9821
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-25
Last Update Date:2023-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care