Provider Demographics
NPI:1265850796
Name:KEITH, ANDREA MICHELLE (FNP-C)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:MICHELLE
Last Name:KEITH
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 1:400 STUART RD NE STE 1
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:TN
Mailing Address - Zip Code:37312-4995
Mailing Address - Country:US
Mailing Address - Phone:423-303-7966
Mailing Address - Fax:423-458-4338
Practice Address - Street 1:400 STUART RD NE STE 1
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:TN
Practice Address - Zip Code:37312-4995
Practice Address - Country:US
Practice Address - Phone:423-303-7966
Practice Address - Fax:423-458-4338
Is Sole Proprietor?:No
Enumeration Date:2014-04-02
Last Update Date:2023-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN18531363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily