Provider Demographics
NPI:1851308191
Name:ANDERSON, KIMBERLY LYNN (FNP-C)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:LYNN
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3070 SKYWAY DR STE 106
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93455-1830
Mailing Address - Country:US
Mailing Address - Phone:805-922-8282
Mailing Address - Fax:805-925-2690
Practice Address - Street 1:3070 SKYWAY DR STE 106
Practice Address - Street 2:
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93455-1830
Practice Address - Country:US
Practice Address - Phone:805-922-8282
Practice Address - Fax:844-278-8613
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2024-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17205363L00000X, 363LF0000X
WA30006873363LF0000X
AK910363LF0000X
TXAP117527363LF0000X, 363LP2300X
NC5009812363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA17205OtherCALIFORNIA BON NURSE PRACTITIONER FURNISHER
WAAP30006873OtherWA STATE DEPARTMENT OF HEALTH ARNP LICENSE
NC5009812OtherNC BON AUTHORIZATION TO PRESCRIBE
WARN00151283OtherWA STATE DOH RN LICENSE
AK12650825OtherCAQH
CA17205OtherCALIFORNIA BON NURSE PRACTITIONER
AK1023099Medicaid
NC5009812OtherNORTH CAROLINA NURSE PRACTITIONER LICENSE
TX9087OtherTEXAS BON RX AUTHORIZATION NUMBER
TXAP117527OtherBON NURSE PRACTITIONER LICENSE
TXAP117527OtherBON NURSE PRACTITIONER LICENSE