Provider Demographics
NPI:1992884720
Name:ANDERSON, JESSICA KATE (NMD)
Entity type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:KATE
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:NMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14015 N 94TH ST
Mailing Address - Street 2:APT 3130
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-3723
Mailing Address - Country:US
Mailing Address - Phone:480-330-2515
Mailing Address - Fax:
Practice Address - Street 1:4440 S RURAL RD
Practice Address - Street 2:BUILDING F, 2ND FLOOR
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-7044
Practice Address - Country:US
Practice Address - Phone:480-883-7240
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ05-886175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath