Provider Demographics
NPI:1932437589
Name:BADER, ANDREW KENT (PA-C)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:KENT
Last Name:BADER
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:ANDREW
Other - Middle Name:KENT
Other - Last Name:BADER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:PO BOX 227
Mailing Address - Street 2:
Mailing Address - City:NIXON
Mailing Address - State:NV
Mailing Address - Zip Code:89424-0227
Mailing Address - Country:US
Mailing Address - Phone:775-574-1018
Mailing Address - Fax:775-574-1028
Practice Address - Street 1:705 HIGHWAY 446
Practice Address - Street 2:
Practice Address - City:NIXON
Practice Address - State:NV
Practice Address - Zip Code:89424
Practice Address - Country:US
Practice Address - Phone:775-574-1018
Practice Address - Fax:775-574-1028
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-19
Last Update Date:2022-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVB0998111NI0013X
NVPA2013363A00000X
NVPA0386363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No111NI0013XChiropractic ProvidersChiropractorIndependent Medical ExaminerGroup - Single Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant