Provider Demographics
NPI:1144310277
Name:ANDERSON, AMY KATHRYN (MD)
Entity type:Individual
Prefix:DR
First Name:AMY
Middle Name:KATHRYN
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:715 N SAINT JOSEPH AVE
Mailing Address - Street 2:
Mailing Address - City:HASTINGS
Mailing Address - State:NE
Mailing Address - Zip Code:68901-4451
Mailing Address - Country:US
Mailing Address - Phone:402-460-5836
Mailing Address - Fax:402-460-5829
Practice Address - Street 1:835 S BURLINGTON AVE
Practice Address - Street 2:SUITE 108
Practice Address - City:HASTINGS
Practice Address - State:NE
Practice Address - Zip Code:68901-6928
Practice Address - Country:US
Practice Address - Phone:402-463-7711
Practice Address - Fax:402-461-5099
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE156602080P0206X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2080P0206XAllopathic & Osteopathic PhysiciansPediatricsPediatric Gastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE15660OtherSTATE LICENSE
AA7539743OtherFEDERAL DEA CERTIFICATE
AA7539743OtherFEDERAL DEA CERTIFICATE