Provider Demographics
NPI:1629136056
Name:LUKE, ANDRA BETH (APRN)
Entity Type:Individual
Prefix:MS
First Name:ANDRA
Middle Name:BETH
Last Name:LUKE
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 1:1500 SW 10TH AVE
Mailing Address - Street 2:MEDICAL STAFF SERVICES
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66604-1301
Mailing Address - Country:US
Mailing Address - Phone:785-354-6241
Mailing Address - Fax:785-270-4343
Practice Address - Street 1:1500 SW 10TH AVE
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66604-1301
Practice Address - Country:US
Practice Address - Phone:785-354-6440
Practice Address - Fax:785-354-5228
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2021-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2014010578363LN0000X
KS76929363LN0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1629136056OtherWEBSITE APPLICATION, NEEDED FOR WORK