Provider Demographics
NPI:1346049160
Name:MANGRUM, ANDREA (NWP)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:MANGRUM
Suffix:
Gender:
Credentials:NWP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 24
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:MS
Mailing Address - Zip Code:38655-0024
Mailing Address - Country:US
Mailing Address - Phone:575-635-9278
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 24
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:MS
Practice Address - Zip Code:38655-0024
Practice Address - Country:US
Practice Address - Phone:575-635-9278
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-12
Last Update Date:2025-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach
No133N00000XDietary & Nutritional Service ProvidersNutritionist