Provider Demographics
NPI:1033727235
Name:WASHINGTON, ANDREA W (FNP-C)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:W
Last Name:WASHINGTON
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4511 KING STATION RD
Mailing Address - Street 2:
Mailing Address - City:MILLINGTON
Mailing Address - State:TN
Mailing Address - Zip Code:38053-7108
Mailing Address - Country:US
Mailing Address - Phone:901-283-9407
Mailing Address - Fax:
Practice Address - Street 1:5220 PARK AVE STE 202
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119-3549
Practice Address - Country:US
Practice Address - Phone:901-305-5040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-14
Last Update Date:2020-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN27188363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily