Provider Demographics
NPI:1588914394
Name:ANDERSON, ANITALYNN M (APRN)
Entity type:Individual
Prefix:
First Name:ANITALYNN
Middle Name:M
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 1:800 HIGHLANDER POINT DR STE 300
Mailing Address - Street 2:
Mailing Address - City:FLOYDS KNOBS
Mailing Address - State:IN
Mailing Address - Zip Code:47119-9465
Mailing Address - Country:US
Mailing Address - Phone:812-923-2273
Mailing Address - Fax:812-923-4100
Practice Address - Street 1:1220 MISSOURI AVE
Practice Address - Street 2:TEAM MEMBER HEALTH
Practice Address - City:JEFFERSONVILLE
Practice Address - State:IN
Practice Address - Zip Code:47130
Practice Address - Country:US
Practice Address - Phone:812-283-2038
Practice Address - Fax:812-283-2057
Is Sole Proprietor?:No
Enumeration Date:2012-09-19
Last Update Date:2022-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71008380A363LF0000X
KY3007496363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100220180Medicaid
KYK063601Medicare PIN
KYK063604Medicare PIN
KYK063605Medicare PIN
KY7100220180Medicaid
KYK063603Medicare PIN
KYK063600Medicare PIN
KYK063602Medicare PIN