Provider Demographics
NPI:1316369051
Name:ANDERSON, AVERY KARYN ERICKSON (MS, RN, FNP-C)
Entity type:Individual
Prefix:MRS
First Name:AVERY
Middle Name:KARYN ERICKSON
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:MS, RN, FNP-C
Other - Prefix:MISS
Other - First Name:AVERY
Other - Middle Name:KARYN FERNANNE
Other - Last Name:ERICKSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BS, RN
Mailing Address - Street 1:PO BOX 313
Mailing Address - Street 2:
Mailing Address - City:LOMA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92354-0313
Mailing Address - Country:US
Mailing Address - Phone:909-800-3768
Mailing Address - Fax:
Practice Address - Street 1:24785 STEWART ST
Practice Address - Street 2:
Practice Address - City:LOMA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92350-1721
Practice Address - Country:US
Practice Address - Phone:909-558-4537
Practice Address - Fax:909-558-0433
Is Sole Proprietor?:No
Enumeration Date:2014-01-15
Last Update Date:2015-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA734395163W00000X
CA95000231363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse