Jacob Rex Andersen

Primary specialty

Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X

Practice address

18701 N 67TH Ave
Glendale, AZ 85308-7100

Phone

(623) 561-1000

NPI assigned

Mar 26, 2025

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1742947200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1742947200000",
    "number": "1811799372",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3971 JOSHUA LN",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834011778",
            "telephone_number": "208-881-7679"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18701 N 67TH AVE",
            "city": "GLENDALE",
            "state": "AZ",
            "postal_code": "853087100",
            "telephone_number": "623-561-1000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ANDERSEN",
        "first_name": "JACOB",
        "middle_name": "REX",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2025-03-26",
        "last_updated": "2025-03-26",
        "certification_date": "2025-03-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sateesh Ananthu, RPH
• Laura Anaya, LPN
• Ancheta Psychological Services PLLC
• Katie Christine Anderkin, MS, CF-SLP
• Chris S. Andersen, MA, LPC, NCC
• Rebecca Andersen, L.A.C.
• Tiffany Andersen, DMD
• Abigail Anderson, DPT
• Alicia Nicole Anderson, DO
• Caitlin Rose Anderson, DPT

• Student in an Organized Health Care Education/Training Program in Glendale, AZ
• Providers in Glendale, AZ by specialty
• Student in an Organized Health Care Education/Training Program in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 26, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.