Provider Demographics
NPI:1730797093
Name:NAYLOR, ANDREA (GERONTOLOGIST)
Entity type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:
Last Name:NAYLOR
Suffix:
Gender:F
Credentials:GERONTOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1393
Mailing Address - Street 2:
Mailing Address - City:AVA
Mailing Address - State:MO
Mailing Address - Zip Code:65608-1393
Mailing Address - Country:US
Mailing Address - Phone:417-543-8818
Mailing Address - Fax:
Practice Address - Street 1:713 JOHNSON AVE
Practice Address - Street 2:
Practice Address - City:AVA
Practice Address - State:MO
Practice Address - Zip Code:65608-5374
Practice Address - Country:US
Practice Address - Phone:417-543-8818
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-22
Last Update Date:2020-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOLC001597872251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health