Provider Demographics
NPI:1063601607
Name:HEBERT, ANDREA NICOLE (PA-C)
Entity type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:NICOLE
Last Name:HEBERT
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2331 FRANKLIN RD SW
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24014-1111
Mailing Address - Country:US
Mailing Address - Phone:540-725-1226
Mailing Address - Fax:540-857-5306
Practice Address - Street 1:2331 FRANKLIN RD SW
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24014-1111
Practice Address - Country:US
Practice Address - Phone:540-725-1226
Practice Address - Fax:540-857-5306
Is Sole Proprietor?:No
Enumeration Date:2007-10-19
Last Update Date:2020-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110002647363A00000X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1063601607OtherANTHEM MEDIGAP
VA1063601607OtherUMWA
VAP00834686OtherRAILROAD MEDICARE
VA1063601607OtherOPTIMA HEALTH PLAN
VA1063601607OtherHUMANA MEDICARE
VA1063601607OtherAETNA
VA1063601607OtherCCC VIRGINIA PREMIER
VA1063601607OtherSOUTHERN HEALTH/CARENET/CARELINK/COVENTRY
VA1063601607OtherINTOTAL
VA1063601607OtherMEDICAID QMB
VA1063601607OtherBLACK LUNG
VA540506332115OtherTRICARE/CHAMPUS
VA1063601607OtherBLACK LUNG