Provider Demographics
NPI:1699736538
Name:ANDERS, KERRY LYNN (MD)
Entity type:Individual
Prefix:DR
First Name:KERRY
Middle Name:LYNN
Last Name:ANDERS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3400 MEDICAL PARK DR
Mailing Address - Street 2:STE A
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71203
Mailing Address - Country:US
Mailing Address - Phone:318-322-7744
Mailing Address - Fax:318-387-3336
Practice Address - Street 1:3400 MEDICAL PARK DR
Practice Address - Street 2:STE A
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71203
Practice Address - Country:US
Practice Address - Phone:318-322-7744
Practice Address - Fax:318-387-3336
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-30
Last Update Date:2008-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD016804207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1354759Medicaid
LAB61983Medicare UPIN
LA1354759Medicaid