Kristen Anderson, FNP
Individual provider Active NPI Family Nurse Practitioner · Germantown, TN
NPI 1639487556 · NPPES record last updated Jun 16, 2018
Key facts
- NPI
- 1639487556
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- License
- APN15091 (TN)
- Practice address
- 1920 Kirby Pkwy Ste 204
Germantown, TN 38138 - Phone
- (901) 350-2639
- Fax
- (901) 249-4563
- NPI assigned
- Sep 14, 2010
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 5
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TN
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20120209000727 | TN | Practitioner - Nurse Practitioner | 9032376645 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 15091 | TN | MD | Pediatrics Physician |
| APN15091 | TN | MD | Family Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Fast Pace Medical Clinic PLLC | Current |
Accepting new patients | |
| Fast Pace Medical Clinic PLLC | Current |
Accepting new patients | |
| Cordova Internal Medicine, PLLC | Past | Accepting new patients | |
| Adult Primary Care of Memphis PC | Past | Accepting new patients | |
| Kroger Limited Partnership I | Past |
Accepting new patients |
Locations
1618 Highway 51 S
Ste Ab
Covington, TN 38019
Phone (931) 332-0961
8118 US Hwy 51 N
Millington, TN 38053
8118 US Hwy 51 N
Millington, TN 38053
Phone (901) 614-4455
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | 15091 | TN | |
| Family Nurse Practitioner | 363LF0000X | 15091 | TN | |
| Family Nurse Practitioner | 363LF0000X | APN15091 | TN | Yes |
Addresses
Primary practice location
1920 Kirby Pkwy Ste 204
Germantown, TN 38138
Mailing address
1920 Kirby Pkwy Ste 204
Germantown, TN 38138-3697
Phone (901) 350-2639
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| Q022569 | Medicaid | TN |
Other providers in Germantown, TN
- American Family Dentistry of Memphis, PC
- Maria E Amos
- Anttrenika Anderson
- Jelisa Anderson
- Keith G Anderson
- Stephanie Ann Anderson
- Toni Andrade
- Anesthesia Healthcare Partners of Tennessee PLLC
- Anesthesia Services Associates, PLLC.
- Anesthesia Services Associates, PLLC.
All providers in Germantown, TN · Family Nurse Practitioner in Tennessee
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 16, 2018. 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.