Provider Demographics
NPI:1962441477
Name:ANDERSON, KARA ELIZABETH
Entity Type:Individual
Prefix:
First Name:KARA
Middle Name:ELIZABETH
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KARA
Other - Middle Name:ELIZABETH
Other - Last Name:JEPPSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 460
Mailing Address - Street 2:1101 MOULTON AND PARSONS DRIVE
Mailing Address - City:ST JAMES
Mailing Address - State:MN
Mailing Address - Zip Code:56081-0460
Mailing Address - Country:US
Mailing Address - Phone:507-375-3391
Mailing Address - Fax:507-375-8635
Practice Address - Street 1:1101 MOULTON AND PARSONS DRIVE
Practice Address - Street 2:
Practice Address - City:ST JAMES
Practice Address - State:MN
Practice Address - Zip Code:56081-0460
Practice Address - Country:US
Practice Address - Phone:507-375-3391
Practice Address - Fax:507-375-8635
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2021-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN200500676822363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily