Basic Information
Provider Information
NPI: 1376039388
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MCKAY
FirstName: ANDREA
MiddleName: N.
NamePrefix:  
NameSuffix:  
Credential: APRN.CNP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1450 COLUMBUS AVENUE
Address2: SUITE B 6-7-8
City: WASHINGTON CH
State: OH
PostalCode: 431603701
CountryCode: US
TelephoneNumber: 7403332236
FaxNumber: 7403333881
Practice Location
Address1: 1510 COLUMBUS AVE STE 230
Address2:  
City: WASHINGTON COURT HOUSE
State: OH
PostalCode: 431601987
CountryCode: US
TelephoneNumber: 7403333333
FaxNumber: 7406361196
Other Information
ProviderEnumerationDate: 07/03/2018
LastUpdateDate: 01/13/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 01/13/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LF0000XAPRN.CNP.023052OHY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily

No ID Information.


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