Provider Demographics
NPI:1710554894
Name:WHALEN, ANDIE RENEE (PA-C)
Entity Type:Individual
Prefix:
First Name:ANDIE
Middle Name:RENEE
Last Name:WHALEN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:ANDIE
Other - Middle Name:
Other - Last Name:MATHIESON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:3010 E BUSINESS 190 STE 254
Mailing Address - Street 2:
Mailing Address - City:COPPERAS COVE
Mailing Address - State:TX
Mailing Address - Zip Code:76522-2517
Mailing Address - Country:US
Mailing Address - Phone:254-577-5642
Mailing Address - Fax:
Practice Address - Street 1:3010 E BUSINESS 190 STE 254
Practice Address - Street 2:
Practice Address - City:COPPERAS COVE
Practice Address - State:TX
Practice Address - Zip Code:76522-2517
Practice Address - Country:US
Practice Address - Phone:254-577-5642
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-08
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical