Provider Demographics
NPI:1619296407
Name:BOUNDS, ANDREA NICHOLE (MD)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:NICHOLE
Last Name:BOUNDS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:630 BURNETT DR
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN HOME
Mailing Address - State:AR
Mailing Address - Zip Code:72653-2941
Mailing Address - Country:US
Mailing Address - Phone:870-425-6971
Mailing Address - Fax:870-508-8900
Practice Address - Street 1:630 BURNETT DR
Practice Address - Street 2:
Practice Address - City:MOUNTAIN HOME
Practice Address - State:AR
Practice Address - Zip Code:72653-2941
Practice Address - Country:US
Practice Address - Phone:870-425-6971
Practice Address - Fax:870-508-8900
Is Sole Proprietor?:No
Enumeration Date:2010-05-19
Last Update Date:2022-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE7518207V00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5RR17OtherBLUE CROSS/BLUE SHIELD
AR199344001Medicaid
AR199344001Medicaid