KELLY A ANDERSON (NPI# 1043592033) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1043592033 |
| Entity Type | Individual |
| Full Name | KELLY A ANDERSON |
| Other Name | KELLY A BRICKLEY |
| Credential | NP |
| Practice Address |
7900 W Jefferson Blvd Suite 304 Fort Wayne IN 46804-4128 |
| Mailing Address |
Po Box 8857 Fort Wayne IN 46898-8857 |
| Practice Telephone | 2609696200 |
| Practice Fax Number | 2609696201 |
| Mailing Telephone | 2609696200 |
| Mailing Fax Number | 2609696201 |
| Enumeration Date | 2011-09-15 |
| Last Update Date | 2012-01-13 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LA2200X |
Nurse Practitioner Specialization: Adult Health |
71003789A | IN | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IN | 201040960 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1083234710 | Kelly Mankin Anderson | Audiologist | 135 Nw 17th St, Bend, OR 97703-2420 | 2020-04-22 |
| 1184255408 | Kelly Marie Anderson | Registered Nurse | 10600 W 500 N, Deputy, IN 47230-8999 | 2020-01-27 |
| 1982188470 | Kelly Brooke Anderson | Clinic/Center | 2215 Veterans Blvd, Metairie, LA 70002 | 2018-09-20 |
| 1457858300 | Kelly R Anderson | Nurse Practitioner | 10120 W Broad St Ste F, Glen Allen, VA 23060-6709 | 2018-04-08 |
| 1538578430 | Kelly Elizabeth Anderson | Student in an Organized Health Care Education/Training Program | 1512 Spreckels St, Honolulu, HI 96822-4658 | 2014-08-05 |
| 1528394681 | Kelly Elizabeth Anderson | Physical Therapist | 1742 Commonwealth Ave, Apt 2, Brighton, MA 02135 | 2009-10-26 |
| 1568694115 | Kelly L Anderson | Physical Therapist | 1325 Spring St., Greenwood, SC 29649 | 2009-08-17 |
| 1255586475 | Kelly Marie Anderson | Nurse's Aide | 1720 17th Ct, Jupiter, FL 33477-9089 | 2008-12-02 |
| 1114056637 | Kelly L Anderson | Social Worker | 655 E. Main St, Children's Hospital Guidance Center, Columbus, OH 43205 | 2007-03-02 |
| 1144828658 | Kelly Herbert Anderson | Social Worker | 220 N Ballston Ave, Scotia, NY 12302-2533 | 2020-10-16 |
| Street Address |
7900 W JEFFERSON BLVD SUITE 304 |
| City | FORT WAYNE |
| State | IN |
| Zip Code | 46804-4128 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1497744437 | Valerie D. Stogdill | Physician Assistant | 7900 W Jefferson Blvd, Suite 201, Fort Wayne, IN 46804-4128 | 2005-10-20 |
| 1922556752 | Carole E. Slater | Registered Nurse | 7900 W Jefferson Blvd, Suite 201, Fort Wayne, IN 46804-4128 | 2016-09-21 |
| 1144694464 | Kendall S. Ray | Dietitian, Registered | 7900 W Jefferson Blvd, Suite 201, Fort Wayne, IN 46804-4128 | 2015-11-24 |
| 1548529084 | Beverly L. Mauger | Nurse Practitioner | 7900 W Jefferson Blvd, Suite 304, Fort Wayne, IN 46804-4128 | 2012-05-03 |
| 1679857502 | Sara J Nevil | Nurse Practitioner | 7900 W Jefferson Blvd, Suite 304, Fort Wayne, IN 46804-4128 | 2011-10-11 |
| 1336460161 | Charles Lee Copeland | Physician Assistant | 7900 W Jefferson Blvd, Suite 304, Fort Wayne, IN 46804-4128 | 2010-06-16 |
| 1679805048 | Michelle Ann Parra | Nurse Practitioner | 7900 W Jefferson Blvd, Ste 304, Fort Wayne, IN 46804-4128 | 2010-02-09 |
| 1861624587 | Benjamin P Merchant | Physical Therapist | 7900 W Jefferson Blvd, Suite 304, Fort Wayne, IN 46804-4128 | 2009-08-13 |
| 1134358005 | Justin D. Brown | Nurse Practitioner | 7900 W Jefferson Blvd, Suite 201, Fort Wayne, IN 46804-4128 | 2009-07-13 |
| 1750516704 | Spine Sports and Pain Medicine, PC | Durable Medical Equipment & Medical Supplies | 7900 W Jefferson Blvd, Suite 304, Fort Wayne, IN 46804-4128 | 2009-05-20 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1396350344 | Derek Mumaw | Physical Therapist | 8420 Illinois Rd, Fort Wayne, IN 46804 | 2020-09-15 |
| 1942840228 | Erin M Mason | Behavior Technician | 5601 Coventry Ln, Fort Wayne, IN 46804 | 2020-01-14 |
| 1346880879 | Emily A Abdalla | Behavior Technician | 5601 Coventry Ln., Fort Wayne, IN 46804 | 2020-01-13 |
| 1083265433 | Fort Wayne Endodontics | Dentist | 9407 Illinois Rd, Fort Wayne, IN 46804 | 2019-09-26 |
| 1689140949 | Harrison Dental Group II, LLC | Dentist | 1333 Getz Rd, Fort Wayne, IN 46804 | 2018-10-15 |
| 1346731908 | Erin Nicole Zimmerman | Nurse Practitioner | 10170 Illinois Rd # 14, Fort Wayne, IN 46804 | 2018-05-19 |
| 1417446022 | Mary Harrington | Physical Therapist | 3320 Copper Hill Run, Fort Wayne, IN 46804 | 2018-05-09 |
| 1942701214 | Joshawa Todd Torres | Marriage & Family Therapist | 5651 Coventry Ln # 116, Fort Wayne, IN 46804 | 2018-02-22 |
| 1194235408 | Mitchell Kory Meyer | Specialist/Technologist | 9125 Yellow Tree Ct, Fort Wayne, IN 46804 | 2017-10-02 |
| 1902324916 | Emily Rene Sagstetter | Specialist/Technologist | 6034 Liberty Glade Ct, Fort Wayne, IN 46804 | 2017-08-30 |
| Find all providers in zip 46804 | ||||
| Taxonomy Code | 363LA2200X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Adult Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548626229 | Tina Duncan | Nurse Practitioner | 6732 Covington Creek Trl, Fort Wayne, IN 46804-2870 | 2016-01-11 |
| 1538486691 | Rounding Providers | Nurse Practitioner | 14411 Smugglers Notch, Fort Wayne, IN 46814-8701 | 2010-04-29 |
| 1245428366 | Damon Greven | Nurse Practitioner | 2512 E Dupont Rd Ste 100, Fort Wayne, IN 46825-1609 | 2007-10-15 |
| 1467658740 | Kimberly E Recht | Nurse Practitioner | 11108 Parkview Circle, Suite 5100, Fort Wayne, IN 46845 | 2007-06-25 |
| 1083827539 | Ruth Elaine Wartell | Nurse Practitioner | 8107 Tranquilla Pl, Fort Wayne, IN 46815-5781 | 2007-05-08 |
| 1285756874 | Timothy John Murphy | Nurse Practitioner | 3617 Rockwood Dr, Fort Wayne, IN 46815-6144 | 2007-04-04 |
| 1962490839 | Peggy A Ryan | Nurse Practitioner | 3512 Stellhorn Rd, Fort Wayne, IN 46815-4631 | 2005-10-13 |
| 1265095897 | Ashley Kamea Lynn Brown | Nurse Practitioner | 6326 Constitution Dr, Fort Wayne, IN 46804-1518 | 2019-04-18 |
| 1104398833 | Jessica Marie Bolton | Nurse Practitioner | 3512 Stellhorn Rd, Fort Wayne, IN 46815 | 2018-12-19 |
| 1750868568 | Shannon E Sitgreaves | Nurse Practitioner | 3512 Stellhorn Rd, Fort Wayne, IN 46815-4631 | 2018-07-24 |
| Find all providers in FORT WAYNE | ||||
| City | FORT WAYNE |
| Zip Code | 46804 |
Please comment or provide details below to improve the information on KELLY A ANDERSON.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.