Provider Demographics
NPI:1376598011
Name:WEDDLE, ANDREA D (FNP)
Entity Type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:D
Last Name:WEDDLE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MISS
Other - First Name:ANDREA
Other - Middle Name:D
Other - Last Name:COLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNM
Mailing Address - Street 1:1097 WESTON DRIVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:MOUNT JULIET
Mailing Address - State:TN
Mailing Address - Zip Code:37122
Mailing Address - Country:US
Mailing Address - Phone:615-553-5002
Mailing Address - Fax:
Practice Address - Street 1:1097 WESTON DRIVE
Practice Address - Street 2:SUITE B
Practice Address - City:MOUNT JULIET
Practice Address - State:TN
Practice Address - Zip Code:37122
Practice Address - Country:US
Practice Address - Phone:615-553-5002
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2023-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN12094363LF0000X, 367A00000X
OHCOA07193NM367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2358676Medicaid
000000252439OtherANTHEM
NM02611OtherPALMETTO MEDICARE
420001752OtherTRAVELERS MEDICARE
000000252439OtherANTHEM