Provider Demographics
NPI:1467805754
Name:KING, ANDREA KATHLEEN (CRNP)
Entity type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:KATHLEEN
Last Name:KING
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:K
Other - Last Name:TANNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4000 LINGLESTOWN RD
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17112-1017
Mailing Address - Country:US
Mailing Address - Phone:717-231-8867
Mailing Address - Fax:717-231-8535
Practice Address - Street 1:4000 LINGLESTOWN RD
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17112-1017
Practice Address - Country:US
Practice Address - Phone:717-231-8867
Practice Address - Fax:717-231-8535
Is Sole Proprietor?:No
Enumeration Date:2016-07-21
Last Update Date:2025-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP016335363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103223639Medicaid