Provider Demographics
NPI:1063470938
Name:MCCARTY, ANDREA B (DO)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:B
Last Name:MCCARTY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:BUTLER
Other - Last Name:MCCARTY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:PO BOX 8035
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67208-0035
Mailing Address - Country:US
Mailing Address - Phone:316-689-9135
Mailing Address - Fax:316-689-9667
Practice Address - Street 1:8444 W 21ST ST N
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67205-1752
Practice Address - Country:US
Practice Address - Phone:316-721-9500
Practice Address - Fax:316-721-9574
Is Sole Proprietor?:No
Enumeration Date:2006-05-02
Last Update Date:2014-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS05-29279207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100412290HMedicaid
003719186OtherMEDICARE
003719186OtherMEDICARE
KS100412290CMedicaid
KS110173175Medicare PIN