Basic Information
| Provider Information | |||||||||
| NPI: | 1235808338 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ANDERSON | ||||||||
| FirstName: | KAYLEIGH | ||||||||
| MiddleName: | |||||||||
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| Credential: | APRN | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 12 | ||||||||
| Address2: | |||||||||
| City: | LIBERTY LAKE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 990190012 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4063273057 | ||||||||
| FaxNumber: | 4063273231 | ||||||||
| Practice Location | |||||||||
| Address1: | 1211 S RESERVE ST STE 101 | ||||||||
| Address2: | |||||||||
| City: | MISSOULA | ||||||||
| State: | MT | ||||||||
| PostalCode: | 598013103 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4063273057 | ||||||||
| FaxNumber: | 4063273231 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/10/2021 | ||||||||
| LastUpdateDate: | 09/29/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/29/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | NUR-RN-LIC-49168 | MT | N | Nursing Service Providers | Registered Nurse | 363LF0000X | NUR-APRN-LIC-177433 | MT | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.