Provider Demographics
NPI:1821434176
Name:ANDRUS, COURTNEY FREESE (PA)
Entity Type:Individual
Prefix:MS
First Name:COURTNEY
Middle Name:FREESE
Last Name:ANDRUS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:13001 N OUTER 40 RD
Mailing Address - Street 2:STE 310
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017-5941
Mailing Address - Country:US
Mailing Address - Phone:314-454-6400
Mailing Address - Fax:314-454-6401
Practice Address - Street 1:13001 N OUTER 40 RD
Practice Address - Street 2:STE 310
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-5941
Practice Address - Country:US
Practice Address - Phone:314-454-6400
Practice Address - Fax:314-454-6401
Is Sole Proprietor?:No
Enumeration Date:2013-05-14
Last Update Date:2021-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2013006724363A00000X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO220039556Medicaid