Katie L. Anderson, PA
Individual provider Active NPI Physician Assistant · Plainfield, CT
NPI 1104195833 · NPPES record last updated Nov 3, 2017
Key facts
- NPI
- 1104195833
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- License
- 3930 (CT)
- Practice address
- 1421 Lowes Way
Plainfield, CT 06374-1963 - Phone
- (860) 317-4000
- Fax
- (860) 317-4030
- NPI assigned
- Dec 27, 2011
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
- Opted out of Medicare
- Yes, effective Jul 1, 2016 through Jul 1, 2028
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2087 | TN | MD | Professional Counselor |
| 3930 | CT | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Premise Health of Connecticut Medical PC | Past | Accepting new patients | |
| Anesthesia Services Associates, PLLC | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 2087 | TN | |
| Physician Assistant | 363A00000X | 3930 | CT | Yes |
Addresses
Primary practice location
1421 Lowes Way
Plainfield, CT 06374-1963
Mailing address
1421 Lowes Way
Plainfield, CT 06374-1963
Phone (860) 317-4000
Other names
- Katie L Sandlin
Other providers in Plainfield, CT
- Cora Marie Abbiati
- Amar A Almidani
- Anastasios Balis
- Urvashi Banerjee
- Zoe Beaver
- Carol Anne Beisser
- Linda Bertelson
All providers in Plainfield, CT · Physician Assistant in Connecticut
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 3, 2017. 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).
- Opt Out Affidavits (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.