Provider Demographics
NPI:1669815759
Name:BAIN, ANDREA CLAYTON (APNC)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:CLAYTON
Last Name:BAIN
Suffix:
Gender:F
Credentials:APNC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 435
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEBURG
Mailing Address - State:TN
Mailing Address - Zip Code:38464-0435
Mailing Address - Country:US
Mailing Address - Phone:931-766-2027
Mailing Address - Fax:855-576-2925
Practice Address - Street 1:2367 HIGHWAY 43 S
Practice Address - Street 2:
Practice Address - City:LEOMA
Practice Address - State:TN
Practice Address - Zip Code:38468-5209
Practice Address - Country:US
Practice Address - Phone:931-766-2027
Practice Address - Fax:855-576-2925
Is Sole Proprietor?:No
Enumeration Date:2013-04-09
Last Update Date:2024-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN17544363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily