Provider Demographics
NPI:1669815049
Name:ANDERSON, SUSAN MELINA (APRN)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:MELINA
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2312 ALEXANDRIA DR
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40504-3229
Mailing Address - Country:US
Mailing Address - Phone:859-276-5344
Mailing Address - Fax:859-296-0362
Practice Address - Street 1:2312 ALEXANDRIA DR
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40504-3229
Practice Address - Country:US
Practice Address - Phone:859-276-5344
Practice Address - Fax:859-296-0362
Is Sole Proprietor?:No
Enumeration Date:2013-04-16
Last Update Date:2020-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3007973363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily