Provider Demographics
NPI:1730375072
Name:ANDRESS, PEGGY (FNP)
Entity type:Individual
Prefix:MS
First Name:PEGGY
Middle Name:
Last Name:ANDRESS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5501 S EXPRESSWAY 77
Mailing Address - Street 2:
Mailing Address - City:HARLINGEN
Mailing Address - State:TX
Mailing Address - Zip Code:78550-3213
Mailing Address - Country:US
Mailing Address - Phone:956-428-5522
Mailing Address - Fax:956-421-2759
Practice Address - Street 1:2310 N ED CAREY DR
Practice Address - Street 2:
Practice Address - City:HARLINGEN
Practice Address - State:TX
Practice Address - Zip Code:78550-8200
Practice Address - Country:US
Practice Address - Phone:956-428-5522
Practice Address - Fax:956-421-2759
Is Sole Proprietor?:No
Enumeration Date:2007-09-20
Last Update Date:2017-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP116238363LF0000X
MI2007004124363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX319663YLPSOtherWELLMED PTAN
TX329126201Medicaid