Provider Demographics
NPI:1790469716
Name:DEASON, ANDREA D
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:D
Last Name:DEASON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1880 S DAIRY ASHFORD RD STE 650
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77077-4847
Mailing Address - Country:US
Mailing Address - Phone:346-422-6758
Mailing Address - Fax:888-388-1481
Practice Address - Street 1:1880 S DAIRY ASHFORD RD STE 650
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77077-4847
Practice Address - Country:US
Practice Address - Phone:346-422-6758
Practice Address - Fax:888-388-1481
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-12
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service