Provider Demographics
NPI:1205386026
Name:ANDRE, KYONGMI (RN)
Entity Type:Individual
Prefix:
First Name:KYONGMI
Middle Name:
Last Name:ANDRE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:518 N 4TH ST
Mailing Address - Street 2:
Mailing Address - City:FLATWOODS
Mailing Address - State:KY
Mailing Address - Zip Code:41139-1086
Mailing Address - Country:US
Mailing Address - Phone:606-694-6840
Mailing Address - Fax:
Practice Address - Street 1:518 N 4TH ST
Practice Address - Street 2:
Practice Address - City:FLATWOODS
Practice Address - State:KY
Practice Address - Zip Code:41139-1086
Practice Address - Country:US
Practice Address - Phone:606-694-6840
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-04
Last Update Date:2016-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV86666163WA2000X, 163WC1600X, 163WC3500X, 163WE0003X, 163WM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WE0003XNursing Service ProvidersRegistered NurseEmergency
No163WA2000XNursing Service ProvidersRegistered NurseAdministrator
No163WC1600XNursing Service ProvidersRegistered NurseContinuing Education/Staff Development
No163WC3500XNursing Service ProvidersRegistered NurseCardiac Rehabilitation
No163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical