Provider Demographics
NPI:1124308408
Name:ANDREAS, KRISTIE MARIE (FNP)
Entity type:Individual
Prefix:
First Name:KRISTIE
Middle Name:MARIE
Last Name:ANDREAS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1057 12TH AVE
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:WA
Mailing Address - Zip Code:98632-2509
Mailing Address - Country:US
Mailing Address - Phone:360-353-3256
Mailing Address - Fax:360-414-1342
Practice Address - Street 1:335 UNA AVE
Practice Address - Street 2:
Practice Address - City:CATHLAMET
Practice Address - State:WA
Practice Address - Zip Code:98612-9583
Practice Address - Country:US
Practice Address - Phone:360-795-3201
Practice Address - Fax:360-795-3209
Is Sole Proprietor?:No
Enumeration Date:2011-08-18
Last Update Date:2022-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60600960363LF0000X, 363LF0000X
TX724896363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2079385Medicaid