Provider Demographics
NPI:1295819175
Name:HAYES, ANDREA KELLEY GORE (APRN, FNP-BC)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:KELLEY GORE
Last Name:HAYES
Suffix:
Gender:F
Credentials:APRN, FNP-BC
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:KELLEY
Other - Last Name:GORE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1505 BONNER WAY
Mailing Address - Street 2:
Mailing Address - City:ESTILL SPRINGS
Mailing Address - State:TN
Mailing Address - Zip Code:37330-4255
Mailing Address - Country:US
Mailing Address - Phone:931-607-0587
Mailing Address - Fax:
Practice Address - Street 1:108 W BLACKWELL ST
Practice Address - Street 2:
Practice Address - City:TULLAHOMA
Practice Address - State:TN
Practice Address - Zip Code:37388-3505
Practice Address - Country:US
Practice Address - Phone:931-841-3821
Practice Address - Fax:931-841-3869
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN8403363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1031057933OtherMEDICARE
TN1510617Medicaid
TN39293822Medicaid
Q21223Medicare UPIN
TN39293822Medicare PIN