Kathleen Andersen, M.D.
Individual provider Active NPI Family Medicine Physician · Sebastopol, CA
NPI 1679570899 · NPPES record last updated Jul 13, 2026
Key facts
- NPI
- 1679570899
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- G58153 (CA)
- Practice address
- 555 Petaluma Ave
#A
Sebastopol, CA 95472-4224 - Phone
- (707) 823-3210
- Fax
- (707) 823-1710
- NPI assigned
- Jul 1, 2005
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| G58153 | CA | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Sutter Bay Medical Foundation | Past | Accepting new patients | |
| Sutter West Bay Medical Foundation | Family Medicine | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | G58153 | CA | Yes |
Addresses
Primary practice location
555 Petaluma Ave
#A
Sebastopol, CA 95472-4224
Mailing address
555 Petaluma Ave
#A
Sebastopol, CA 95472-4224
Phone (707) 823-3210
Other providers in Sebastopol, CA
- Mary Altenau
- American Specialty Physicians Group Inc
- Amitabha Medical Clinic & Healing Center
- Danielle Laura Amorelli
- Kara Andersen
- Kathryn Anderson
- Andrea E Kirk PHD
- Charles Philip Andrews
- Allie M Andrus McCann
- Holly Anton
All providers in Sebastopol, CA · Family Medicine Physician in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 13, 2026. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.