Provider Demographics
NPI:1376095596
Name:DR. ANDREA'S MEDICAL & WEIGHT LOSS CLINIC, PLLC
Entity Type:Organization
Organization Name:DR. ANDREA'S MEDICAL & WEIGHT LOSS CLINIC, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDRE
Authorized Official - Middle Name:
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:DNP, FNP-C
Authorized Official - Phone:901-573-6765
Mailing Address - Street 1:8317 CORDOVA RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38016-2088
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8317 CORDOVA RD
Practice Address - Street 2:SUITE 201
Practice Address - City:CORDOVA
Practice Address - State:TN
Practice Address - Zip Code:38016-2088
Practice Address - Country:US
Practice Address - Phone:901-573-6765
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-04
Last Update Date:2016-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000011998261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty