| Doctor Name: | WILLARD MARVIN ANDERSON |
| NPI Number: | 1063756211 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PMHNP |
| License Number: | 9348879 |
| Business Practice Address: | 3686 Us Highway 331 S Defuniak Springs, FL - 324358463 |
| Business Phone Number: | 8508928045 |
| Business Fax Number: | |
| Mailing Address: | 3686 Us Highway 331 S, DEFUNIAK SPRINGS |
| State: | FL |
| Postal Code: | 324358463 |
| Phone Number: | 8508928045 |
| Fax Number: | |
| NPI Enumeration Date: | 11/11/2012 |
| NPI Last Update Date: | 11/11/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LP0808X |
| License Number: | 9348879 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | FL |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Psych/Mental Health |
| Taxonomy Definition: | |