Provider Demographics
NPI:1467805754
Name:KING, ANDREA KATHLEEN (CRNP)
Entity Type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:KATHLEEN
Last Name:KING
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3421 CONCORD RD
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17402-9001
Mailing Address - Country:US
Mailing Address - Phone:717-812-5190
Mailing Address - Fax:
Practice Address - Street 1:1227 BALTIMORE ST
Practice Address - Street 2:
Practice Address - City:HANOVER
Practice Address - State:PA
Practice Address - Zip Code:17331-4406
Practice Address - Country:US
Practice Address - Phone:717-812-5190
Practice Address - Fax:717-637-2245
Is Sole Proprietor?:No
Enumeration Date:2016-07-21
Last Update Date:2022-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP016335363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103223639Medicaid