Provider Demographics
NPI:1629406491
Name:KNEIB, ANDREW KEITH (PA-C)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:KEITH
Last Name:KNEIB
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:536 W 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:GARNETT
Mailing Address - State:KS
Mailing Address - Zip Code:66032-1355
Mailing Address - Country:US
Mailing Address - Phone:785-448-2674
Mailing Address - Fax:
Practice Address - Street 1:536 W 4TH AVE
Practice Address - Street 2:
Practice Address - City:GARNETT
Practice Address - State:KS
Practice Address - Zip Code:66032-1355
Practice Address - Country:US
Practice Address - Phone:785-448-2674
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-14
Last Update Date:2013-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS15-01651363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant