Basic Information
| Provider Information | |||||||||
| NPI: | 1639746589 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ANDERSON | ||||||||
| FirstName: | NATALIE | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | AGACNP-BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 432 AGEE ST | ||||||||
| Address2: | |||||||||
| City: | HARRODSBURG | ||||||||
| State: | KY | ||||||||
| PostalCode: | 403307506 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5025989862 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1760 NICHOLASVILLE RD | ||||||||
| Address2: | |||||||||
| City: | LEXINGTON | ||||||||
| State: | KY | ||||||||
| PostalCode: | 405031471 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8592606100 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/09/2021 | ||||||||
| LastUpdateDate: | 06/09/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/09/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2100X | 3016214 | KY | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Acute Care |
ID Information
| ID | Type | State | Issuer | Description | 3016214 | 01 | KY | APRN LICENSE NUMBER | OTHER |