Provider Demographics
NPI:1912605262
Name:VENABLE, ANDREW (PA)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:
Last Name:VENABLE
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 MOUNTAIN CREST LN
Mailing Address - Street 2:
Mailing Address - City:GREENBACK
Mailing Address - State:TN
Mailing Address - Zip Code:37742-2479
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:125 TOWN CREEK RD E STE 3
Practice Address - Street 2:
Practice Address - City:LENOIR CITY
Practice Address - State:TN
Practice Address - Zip Code:37772-5690
Practice Address - Country:US
Practice Address - Phone:865-986-2700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-16
Last Update Date:2023-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN000000-850213ES0103X
TN5388363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
1204238OtherNCCPA