Provider Demographics
NPI:1225662174
Name:ANDERSON, KRISTIN JOY (FNP)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:JOY
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15391 CREEKSIDE LN
Mailing Address - Street 2:
Mailing Address - City:OSSEO
Mailing Address - State:MN
Mailing Address - Zip Code:55369-2646
Mailing Address - Country:US
Mailing Address - Phone:612-508-6062
Mailing Address - Fax:
Practice Address - Street 1:14000 NICOLLET AVE STE 304
Practice Address - Street 2:
Practice Address - City:BURNSVILLE
Practice Address - State:MN
Practice Address - Zip Code:55337-5784
Practice Address - Country:US
Practice Address - Phone:952-898-1600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-01
Last Update Date:2024-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN7625363LF0000X
MN1556605363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily