Provider Demographics
NPI:1376143529
Name:HALL, ANDREA LEWIS (NP)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:LEWIS
Last Name:HALL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14721 ARBORCREST DR
Mailing Address - Street 2:
Mailing Address - City:BALCH SPRINGS
Mailing Address - State:TX
Mailing Address - Zip Code:75180-3642
Mailing Address - Country:US
Mailing Address - Phone:972-310-1440
Mailing Address - Fax:
Practice Address - Street 1:14721 ARBORCREST DR
Practice Address - Street 2:
Practice Address - City:BALCH SPRINGS
Practice Address - State:TX
Practice Address - Zip Code:75180-3642
Practice Address - Country:US
Practice Address - Phone:972-310-1440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-27
Last Update Date:2022-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX611521163WE0003X
TX1027664363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No163WE0003XNursing Service ProvidersRegistered NurseEmergency