Provider Demographics
NPI:1487178992
Name:DAVIS, ANDREA HUERTA (APRN, FNP-C)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:HUERTA
Last Name:DAVIS
Suffix:
Gender:F
Credentials:APRN, FNP-C
Other - Prefix:MRS
Other - First Name:ANDREA
Other - Middle Name:CECILIA
Other - Last Name:HUERTA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN, BSN
Mailing Address - Street 1:3901 HOUMA BLVD STE 108
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70006-2930
Mailing Address - Country:US
Mailing Address - Phone:504-779-3507
Mailing Address - Fax:504-779-3508
Practice Address - Street 1:3901 HOUMA BLVD STE 501
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70006-2927
Practice Address - Country:US
Practice Address - Phone:504-779-3507
Practice Address - Fax:504-779-3508
Is Sole Proprietor?:No
Enumeration Date:2017-07-27
Last Update Date:2022-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP09474363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2455648Medicaid