Provider Demographics
NPI:1639560055
Name:DELL, ANDREW
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:
Last Name:DELL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5818 COVEY LN
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75703-4501
Mailing Address - Country:US
Mailing Address - Phone:615-891-8407
Mailing Address - Fax:
Practice Address - Street 1:8080 E CENTRAL AVE
Practice Address - Street 2:SUITE 250
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67206-2368
Practice Address - Country:US
Practice Address - Phone:316-686-7327
Practice Address - Fax:316-686-1557
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-06
Last Update Date:2022-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP128139207L00000X, 367500000X
KS557317367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP01536077OtherRAIL ROAD
TX351031501Medicaid
TX75-0818167-015OtherTRICARE
TX351031501Medicaid