Provider Demographics
NPI:1164405569
Name:ANDREWS, ALLYSON MALONE (PA-C)
Entity Type:Individual
Prefix:
First Name:ALLYSON
Middle Name:MALONE
Last Name:ANDREWS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BUCKHANNON
Mailing Address - State:WV
Mailing Address - Zip Code:26201-2235
Mailing Address - Country:US
Mailing Address - Phone:304-473-5600
Mailing Address - Fax:304-472-1341
Practice Address - Street 1:37 W MAIN ST
Practice Address - Street 2:
Practice Address - City:BUCKHANNON
Practice Address - State:WV
Practice Address - Zip Code:26201-2235
Practice Address - Country:US
Practice Address - Phone:304-473-5600
Practice Address - Fax:304-472-1341
Is Sole Proprietor?:No
Enumeration Date:2005-11-21
Last Update Date:2022-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV952363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810000530Medicaid
WV2029673Medicare PIN
WV2029675Medicare PIN
WV2029674Medicare PIN
WV2029671Medicare PIN
WV3810000530Medicaid
WV2029672Medicare PIN