Provider Demographics
NPI:1174601017
Name:BLEVINS, ANDREA G (ANP)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:G
Last Name:BLEVINS
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10046 OLD LIBERTY RD
Mailing Address - Street 2:
Mailing Address - City:LIBERTY
Mailing Address - State:NC
Mailing Address - Zip Code:27298-8071
Mailing Address - Country:US
Mailing Address - Phone:366-622-6000
Mailing Address - Fax:336-622-7818
Practice Address - Street 1:3803 N ELM ST
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27455-2593
Practice Address - Country:US
Practice Address - Phone:336-549-9846
Practice Address - Fax:877-720-2076
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2015-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC005001746363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC005001746OtherNC LICENSE NUMBER