Provider Demographics
NPI:1730833112
Name:KEVRESIAN, ANDREA LYNN (FNP-C)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:LYNN
Last Name:KEVRESIAN
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:LYNN
Other - Last Name:TALLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1901 W KANSAS ST
Mailing Address - Street 2:
Mailing Address - City:LIBERTY
Mailing Address - State:MO
Mailing Address - Zip Code:64068-2060
Mailing Address - Country:US
Mailing Address - Phone:816-781-0035
Mailing Address - Fax:
Practice Address - Street 1:1901 W KANSAS ST
Practice Address - Street 2:
Practice Address - City:LIBERTY
Practice Address - State:MO
Practice Address - Zip Code:64068-2060
Practice Address - Country:US
Practice Address - Phone:816-781-0035
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-04
Last Update Date:2022-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS53-80725-101363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily