Provider Demographics
NPI:1982292231
Name:ANDERSON, CODY LASHAY (RN)
Entity Type:Individual
Prefix:
First Name:CODY
Middle Name:LASHAY
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:PROF
Other - First Name:CODY
Other - Middle Name:LASHAY
Other - Last Name:ANDERSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN, BSN
Mailing Address - Street 1:2004 EDMONIA CT
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76105-2821
Mailing Address - Country:US
Mailing Address - Phone:817-209-9103
Mailing Address - Fax:281-606-0354
Practice Address - Street 1:4333 WESTERN CENTER BLVD
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76137-2036
Practice Address - Country:US
Practice Address - Phone:817-232-1634
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-04
Last Update Date:2021-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX912117163WP0200X, 163WE0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WE0003XNursing Service ProvidersRegistered NurseEmergencyGroup - Single Specialty
No163WP0200XNursing Service ProvidersRegistered NursePediatricsGroup - Single Specialty