Provider Demographics
NPI:1508290966
Name:WHIDDON, ANDREA L (NP-C)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:L
Last Name:WHIDDON
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:535 SHANKLIN RD
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31705-4801
Mailing Address - Country:US
Mailing Address - Phone:229-881-6350
Mailing Address - Fax:
Practice Address - Street 1:211 N JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31701-2548
Practice Address - Country:US
Practice Address - Phone:229-485-1647
Practice Address - Fax:292-375-0766
Is Sole Proprietor?:No
Enumeration Date:2013-08-21
Last Update Date:2024-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN171380363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner