Provider Demographics
NPI:1275548109
Name:CHENEWETH, ANDREA E (FNP)
Entity Type:Individual
Prefix:MS
First Name:ANDREA
Middle Name:E
Last Name:CHENEWETH
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6250 JOHN RYAN DR
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76132-4115
Mailing Address - Country:US
Mailing Address - Phone:817-346-9800
Mailing Address - Fax:817-346-9881
Practice Address - Street 1:6250 JOHN RYAN DR
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76132-4115
Practice Address - Country:US
Practice Address - Phone:817-346-9800
Practice Address - Fax:817-346-9881
Is Sole Proprietor?:No
Enumeration Date:2006-07-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX635486363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX635486OtherSTATE LICENSE