Provider Demographics
NPI:1205671914
Name:PAINTER, ANDREA NICOLE (PA)
Entity type:Individual
Prefix:MS
First Name:ANDREA
Middle Name:NICOLE
Last Name:PAINTER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:864 SATINWOOD CT
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28312-8110
Mailing Address - Country:US
Mailing Address - Phone:636-696-3579
Mailing Address - Fax:
Practice Address - Street 1:3650 CAPE CENTER DR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-2139
Practice Address - Country:US
Practice Address - Phone:910-483-0049
Practice Address - Fax:910-339-8905
Is Sole Proprietor?:No
Enumeration Date:2024-06-26
Last Update Date:2025-07-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC0010-15401363A00000X
MO2024035199363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO220147013Medicaid