Provider Demographics
NPI:1982925475
Name:MCGREW, ANDREA NICHOLE (RDN/LD)
Entity type:Individual
Prefix:MS
First Name:ANDREA
Middle Name:NICHOLE
Last Name:MCGREW
Suffix:
Gender:
Credentials:RDN/LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15542 OLD OAK CT
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39503-9096
Mailing Address - Country:US
Mailing Address - Phone:417-825-8847
Mailing Address - Fax:
Practice Address - Street 1:15542 OLD OAK CT
Practice Address - Street 2:
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39503-9096
Practice Address - Country:US
Practice Address - Phone:417-825-8847
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-18
Last Update Date:2025-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2010001121133V00000X
MSD-2179133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO133V00000XMedicaid