Provider Demographics
NPI:1891049086
Name:BEARD, ANDREA D (FNP)
Entity Type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:D
Last Name:BEARD
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:D
Other - Last Name:WHITMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN/FNP
Mailing Address - Street 1:7333 W JEFFERSON BLVD
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46804-6280
Mailing Address - Country:US
Mailing Address - Phone:260-435-7560
Mailing Address - Fax:260-435-7747
Practice Address - Street 1:7333 W JEFFERSON BLVD
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46804-6280
Practice Address - Country:US
Practice Address - Phone:260-435-7560
Practice Address - Fax:260-435-7747
Is Sole Proprietor?:No
Enumeration Date:2012-11-09
Last Update Date:2021-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71004418A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201153130Medicaid
IN25260012Medicare PIN