Provider Demographics
NPI:1255384061
Name:MCNIEL, ANDREA M (PA)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:M
Last Name:MCNIEL
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25511 BUDDE RD STE 2502
Mailing Address - Street 2:
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77380-2388
Mailing Address - Country:US
Mailing Address - Phone:936-441-1010
Mailing Address - Fax:866-475-9062
Practice Address - Street 1:18955 N MEMORIAL DR STE 240
Practice Address - Street 2:
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77338-4271
Practice Address - Country:US
Practice Address - Phone:936-441-1010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2019-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA04340363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX182844401Medicaid
TX182844401Medicaid