Provider Demographics
NPI:1790151165
Name:MCKINNOND, ANDREA ELIZABETH (PA)
Entity Type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:ELIZABETH
Last Name:MCKINNOND
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Gender:F
Credentials:PA
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Mailing Address - Street 1:DEPARTMENT OF OTOLARYNGOLOGY HEAD AND NECK
Mailing Address - Street 2:MEDICAL CENTER BLVD
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27157-0001
Mailing Address - Country:US
Mailing Address - Phone:336-716-3854
Mailing Address - Fax:336-716-3857
Practice Address - Street 1:DEPARTMENT OF OTOLARYNGOLOGY HEAD AND NECK
Practice Address - Street 2:MEDICAL CENTER BLVD
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27157-0001
Practice Address - Country:US
Practice Address - Phone:336-716-4161
Practice Address - Fax:336-716-9440
Is Sole Proprietor?:No
Enumeration Date:2015-08-19
Last Update Date:2019-12-23
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Provider Licenses
StateLicense IDTaxonomies
NC0010-05903363AS0400X, 363AM0700X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical