Provider Demographics
NPI:1427517309
Name:HAGGARD, ANDREA JENEEN (FNP-C)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:JENEEN
Last Name:HAGGARD
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2409 MEMBERS WAY
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40504-3360
Mailing Address - Country:US
Mailing Address - Phone:859-492-0812
Mailing Address - Fax:
Practice Address - Street 1:2409 MEMBERS WAY
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40504-3360
Practice Address - Country:US
Practice Address - Phone:859-492-0812
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-19
Last Update Date:2019-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3011788363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily