Provider Demographics
NPI:1336640127
Name:ANDRES, MEGAN (APRN)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:ANDRES
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:49 HIGHWAY 62 412
Mailing Address - Street 2:
Mailing Address - City:ASH FLAT
Mailing Address - State:AR
Mailing Address - Zip Code:72513-9594
Mailing Address - Country:US
Mailing Address - Phone:870-994-7031
Mailing Address - Fax:
Practice Address - Street 1:1016 NORTH FOURCHE AVENUE
Practice Address - Street 2:
Practice Address - City:PERRYVILLE
Practice Address - State:AR
Practice Address - Zip Code:72126-7257
Practice Address - Country:US
Practice Address - Phone:501-238-1284
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-27
Last Update Date:2018-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA005491363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily