Provider Demographics
NPI:1477852978
Name:PEEVY, ANDREA ANDERSON (APRN)
Entity Type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:ANDERSON
Last Name:PEEVY
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:MRS
Other - First Name:ANDREA
Other - Middle Name:CLARE
Other - Last Name:ANDERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:SLU 10734
Mailing Address - Street 2:
Mailing Address - City:HAMMOND
Mailing Address - State:LA
Mailing Address - Zip Code:70402-3147
Mailing Address - Country:US
Mailing Address - Phone:985-549-2242
Mailing Address - Fax:985-549-2093
Practice Address - Street 1:WAR MEMORIAL STUDENT UNION ANX
Practice Address - Street 2:
Practice Address - City:HAMMOND
Practice Address - State:LA
Practice Address - Zip Code:70402-4142
Practice Address - Country:US
Practice Address - Phone:985-643-0075
Practice Address - Fax:985-646-0430
Is Sole Proprietor?:No
Enumeration Date:2011-03-23
Last Update Date:2017-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP06422363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2162781Medicaid
LA2162781Medicaid