Provider Demographics
NPI:1508284845
Name:IRWIN, ANDREA NOBLE (APRN)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:NOBLE
Last Name:IRWIN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 936
Mailing Address - Street 2:
Mailing Address - City:LONDON
Mailing Address - State:KY
Mailing Address - Zip Code:40743-0936
Mailing Address - Country:US
Mailing Address - Phone:606-330-7818
Mailing Address - Fax:606-330-7825
Practice Address - Street 1:4371 NEW SHEPHERDSVILLE RD
Practice Address - Street 2:SUITE 210
Practice Address - City:BARDSTOWN
Practice Address - State:KY
Practice Address - Zip Code:40004-8040
Practice Address - Country:US
Practice Address - Phone:502-350-5373
Practice Address - Fax:502-350-5374
Is Sole Proprietor?:No
Enumeration Date:2014-04-03
Last Update Date:2019-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3008571363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily