Provider Demographics
NPI:1659763993
Name:BLAES, ANDREW JOSEPH (NP)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:JOSEPH
Last Name:BLAES
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:ANDREW
Other - Middle Name:JOSEPH
Other - Last Name:BLAES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSN, APRN, ACNP-C
Mailing Address - Street 1:PO BOX 3810
Mailing Address - Street 2:
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64803-3810
Mailing Address - Country:US
Mailing Address - Phone:417-347-4662
Mailing Address - Fax:
Practice Address - Street 1:3105 MCCLELLAND BLVD.
Practice Address - Street 2:
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804-1640
Practice Address - Country:US
Practice Address - Phone:417-347-5400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-24
Last Update Date:2022-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2015005447363L00000X, 363LA2100X, 363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS53-77168-032OtherKANSAS NURSING LICENSE