Provider Demographics
NPI:1144486531
Name:PAUL, ANDREA (PA)
Entity type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:
Last Name:PAUL
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2214 CANTERBURY DR
Mailing Address - Street 2:STE 202
Mailing Address - City:HAYS
Mailing Address - State:KS
Mailing Address - Zip Code:67601-2386
Mailing Address - Country:US
Mailing Address - Phone:785-623-2312
Mailing Address - Fax:785-623-2323
Practice Address - Street 1:2214 CANTERBURY DR
Practice Address - Street 2:STE 202
Practice Address - City:HAYS
Practice Address - State:KS
Practice Address - Zip Code:67601-2386
Practice Address - Country:US
Practice Address - Phone:785-623-2312
Practice Address - Fax:785-623-2323
Is Sole Proprietor?:No
Enumeration Date:2008-08-05
Last Update Date:2008-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KST-02175363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant