Kelly Anderson
Individual provider Active NPI Student in an Organized Health Care Education/Training Program · Augusta, ME
NPI 1003700709 · NPPES record last updated Jun 6, 2025
Key facts
- NPI
- 1003700709
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Student in an Organized Health Care Education/Training Program 390200000X
- License
- TP25119 (ME)
- Practice address
- 15 E Chestnut St
Augusta, ME 04330-5736 - Phone
- (207) 626-1561
- Fax
- (207) 626-1849
- NPI assigned
- Jun 6, 2025
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in ME
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20250716002338 | ME | Order and Referring Only - Family Practice |
5698280709 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| TP25119 | ME | MD | Student in an Organized Health Care Education/Training Program |
Interoperability endpoints
- kellyanderson@mgh.allscriptsdirect.net
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | TP25119 | ME | Yes |
Addresses
Primary practice location
15 E Chestnut St
Augusta, ME 04330-5736
Mailing address
15 E Chestnut St
Augusta, ME 04330-5736
Phone (207) 626-1561
Other providers in Augusta, ME
- Darby Amelly
- American Current Care, P.a.
- Bridget Alice Amundsen
- Alyne Newell Anderson
- Katharine M K Anderson
- Lisa Marie Anderson
- Linnea Pia Andersson
- Andre Nadeau Chiropractic P.C.
- Nicholas Scott Andresen
- Gretchen M Andrews
All providers in Augusta, ME · Student in an Organized Health Care Education/Training Program in Maine
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 6, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.