Kim Anderson, FNP-BC

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

277001265 Issued in IL

Practice address

2845 N Sheridan Road
Suite 907
Chicago, IL 60657

Phone

(773) 295-0707

Fax

(872) 243-2843

NPI assigned

Jun 10, 2017

Last updated

Apr 20, 2022By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 5

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

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.

• New Leaf Wellness & Behavioral Health LLC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Las Vegas, NV
  • NPI 1194335554
  NPD Authorized official
• Paragon Clinical Midwest, LLC

  • Nurse Practitioner
  • Merrillville, IN
  • NPI 1619335700
  NPD (past)

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

{
    "created_epoch": "1497052800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1650412800000",
    "number": "1841729985",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2845 N SHERIDAN ROAD",
            "address_2": "SUITE 907",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "60657",
            "telephone_number": "773-295-0707",
            "fax_number": "872-243-2843"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2845 N SHERIDAN ROAD",
            "address_2": "SUITE 907",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "60657",
            "telephone_number": "773-295-0707",
            "fax_number": "872-243-2843"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "14121 Parke Long Ct",
            "address_purpose": "LOCATION",
            "city": "Chantilly",
            "state": "VA",
            "postal_code": "201511647",
            "country_code": "US",
            "telephone_number": "855-247-1940",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3430 E Flamingo Rd Ste 244",
            "address_purpose": "LOCATION",
            "city": "Las Vegas",
            "state": "NV",
            "postal_code": "891215020",
            "country_code": "US",
            "telephone_number": "219-973-7159",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ANDERSON",
        "first_name": "KIM",
        "name_prefix": "Mrs.",
        "credential": "FNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-06-10",
        "last_updated": "2022-04-20",
        "certification_date": "2022-04-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NV",
            "license": "832075",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IN",
            "license": "28194001A",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IL",
            "license": "209017385",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "IL",
            "license": "277001265",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Karla V Anderson, PSY.D.
• Katherine Anderson, APN
• Kayley Anderson, MSW
• Kelley Marie Anderson, APN
• Kelly Anderson, PHARM.D,CCP
• Kristen E Anderson, LCPC
• Kristen Elizabeth Anderson, MA, LCSW
• Kristen Marie Anderson
• Kristina L Anderson, CSSW
• Kyle D Anderson, PHD

• Psychiatric/Mental Health Nurse Practitioner in Chicago, IL
• Providers in Chicago, IL by specialty
• Psychiatric/Mental Health Nurse Practitioner in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.