Provider Demographics
NPI:1790818250
Name:MAGGARD, ANDREA LYNN (FNP)
Entity Type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:LYNN
Last Name:MAGGARD
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15441 US HIGHWAY 17 STE 501
Mailing Address - Street 2:
Mailing Address - City:HAMPSTEAD
Mailing Address - State:NC
Mailing Address - Zip Code:28443-0016
Mailing Address - Country:US
Mailing Address - Phone:910-685-7307
Mailing Address - Fax:910-685-7284
Practice Address - Street 1:15441 US HIGHWAY 17 STE 501
Practice Address - Street 2:
Practice Address - City:HAMPSTEAD
Practice Address - State:NC
Practice Address - Zip Code:28443-0016
Practice Address - Country:US
Practice Address - Phone:910-685-7307
Practice Address - Fax:910-685-7284
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2021-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY5172P363LF0000X
OHRX 08595363LF0000X
NC5011581363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily