Provider Demographics
NPI:1427348929
Name:ANDERSON, JAMES LAMONT (PMHNP)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:LAMONT
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:308 PALO DURO
Mailing Address - Street 2:
Mailing Address - City:ALAMOGORDO
Mailing Address - State:NM
Mailing Address - Zip Code:88310-8513
Mailing Address - Country:US
Mailing Address - Phone:720-236-6024
Mailing Address - Fax:
Practice Address - Street 1:4704 HARLAN ST STE 103
Practice Address - Street 2:
Practice Address - City:WHEAT RIDGE
Practice Address - State:CO
Practice Address - Zip Code:80212-7411
Practice Address - Country:US
Practice Address - Phone:720-310-2773
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-18
Last Update Date:2020-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO171197163W00000X
NM54434363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse