Provider Demographics
NPI:1417443060
Name:KEITH, ANDREA FAY (APRN, FNP-C)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:FAY
Last Name:KEITH
Suffix:
Gender:F
Credentials:APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17834 MAPLE ASH DR
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77379-1555
Mailing Address - Country:US
Mailing Address - Phone:281-682-7981
Mailing Address - Fax:
Practice Address - Street 1:2829 TECHNOLOGY FOREST BLVD STE 140
Practice Address - Street 2:
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77381-3913
Practice Address - Country:US
Practice Address - Phone:281-223-1124
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-06
Last Update Date:2020-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP137899363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily