Individual provider Active NPI

Kristen Elizabeth Anderson, PA-C

  • Physician Assistant
  • Dover, DE
National Provider Identifier
1780862706
Registry record updated Jul 26, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
C5-0000611 Issued in DE
Practice address
793 S Queen St
Dover, DE 19904-3568
Phone
(302) 744-9310
Fax
(302) 744-9312
NPI assigned
Jan 31, 2008
Last updated
Jul 26, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 26, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X C5-0000611 DE Primary

Addresses

Primary practice location

793 S Queen St
Dover, DE 19904-3568

Mailing address

640 S. State Street
Mail Code 3055
Dover, DE 19901-3530
Phone (302) 480-1688

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in DE
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100125000697 DE Practitioner - Physician Assistant 2860534146 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Drexel University College of Medicine, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Bayhealth Medical Center, IncGroup PAC ID 1658364740, 399 clinicians

Practice addresses (Care Compare)

200 Banning St
Suite 340
Dover, DE 19904-3490
Phone (302) 734-1414

640 S State St
Dover, DE 19901-3530

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
C5-0000611DEMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Bayhealth Medical Center, Inc CurrentSince May 4, 2025 Accepting new patients
Bayhealth Medical Center, Inc CurrentSince Aug 13, 2019 Accepting new patients
Bayhealth Medical Center, Inc CurrentSince Aug 13, 2019 Accepting new patients
Bayhealth Medical Center, Inc Past Accepting new patients
Delaware Heart & Vascular, P.a. Past Accepting new patients

Locations

200 Banning St
Ste 340
Dover, DE 19904
Phone (302) 734-1414

560 S Governors Ave
Dover, DE 19904
Phone (302) 310-8484

640 S State St
Dover, DE 19901
Phone (302) 744-4700

640 S State St
#3055
Dover, DE 19901
Phone (302) 480-1688

793 S Queen St
Dover, DE 19904
Phone (302) 674-4401

21 W Clarke Ave
Milford, DE 19963
Phone (302) 422-3311

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 5

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1201737600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1690329600000",
    "number": "1780862706",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "640 S. STATE STREET",
            "address_2": "MAIL CODE 3055",
            "city": "DOVER",
            "state": "DE",
            "postal_code": "199013530",
            "telephone_number": "302-480-1688",
            "fax_number": "302-480-9807"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "793 S QUEEN ST",
            "city": "DOVER",
            "state": "DE",
            "postal_code": "199043568",
            "telephone_number": "302-744-9310",
            "fax_number": "302-744-9312"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ANDERSON",
        "first_name": "KRISTEN",
        "middle_name": "ELIZABETH",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-01-31",
        "last_updated": "2023-07-26",
        "certification_date": "2023-07-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "DE",
            "license": "C5-0000611",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Dover, DE

Sources for this page

Verify at the official NPI Registry.