Provider Demographics
NPI:1952500340
Name:ANDERSON, VALERIE A (RN, BSN, MSN, ARNP)
Entity Type:Individual
Prefix:MRS
First Name:VALERIE
Middle Name:A
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:RN, BSN, MSN, ARNP
Other - Prefix:MS
Other - First Name:VALERIE
Other - Middle Name:A
Other - Last Name:DIRKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 8035
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67208
Mailing Address - Country:US
Mailing Address - Phone:316-689-9135
Mailing Address - Fax:316-689-9667
Practice Address - Street 1:101 E ROSS ST
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:KS
Practice Address - Zip Code:67026-7824
Practice Address - Country:US
Practice Address - Phone:316-866-2000
Practice Address - Fax:316-866-2084
Is Sole Proprietor?:No
Enumeration Date:2007-07-16
Last Update Date:2019-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS13-80994-082163W00000X
KS46065363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200461240IMedicaid
003719260OtherMEDICARE