Provider Demographics
NPI:1538260575
Name:KING, ANDREA A (PA-C)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:A
Last Name:KING
Suffix:
Gender:F
Credentials:PA-C
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Mailing Address - Street 1:PO BOX 802843
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64180-2843
Mailing Address - Country:US
Mailing Address - Phone:417-730-6430
Mailing Address - Fax:417-269-7567
Practice Address - Street 1:3525 S NATIONAL AVE STE 205A
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65807-7315
Practice Address - Country:US
Practice Address - Phone:417-269-9714
Practice Address - Fax:417-269-9236
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2022-09-27
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Provider Licenses
StateLicense IDTaxonomies
MO2017033358363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
203483OtherBLUE CROSS OF MO
MO131620001Medicare Oscar/Certification