Provider Demographics
NPI:1780159533
Name:GERNAND, ANDREW KENNETH (PA-C)
Entity type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:KENNETH
Last Name:GERNAND
Suffix:
Gender:M
Credentials:PA-C
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Mailing Address - Street 1:2406 CLINTON AVE APT F21
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55404-3612
Mailing Address - Country:US
Mailing Address - Phone:507-319-3765
Mailing Address - Fax:
Practice Address - Street 1:640 JACKSON ST
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55101-2595
Practice Address - Country:US
Practice Address - Phone:651-254-9426
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-08
Last Update Date:2022-09-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MN12808363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN12808OtherMINNESOTA BOARD OF MEDICAL PRACTICE