Provider Demographics
NPI:1447895891
Name:KISHBAUGH, ANDREA (FNP-C)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:KISHBAUGH
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 1:2109 VALLEYGATE DR STE 201
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28304-3571
Mailing Address - Country:US
Mailing Address - Phone:910-486-8880
Mailing Address - Fax:910-486-8886
Practice Address - Street 1:2109 VALLEYGATE DR STE 201
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-3571
Practice Address - Country:US
Practice Address - Phone:910-486-8880
Practice Address - Fax:910-486-8886
Is Sole Proprietor?:No
Enumeration Date:2019-11-08
Last Update Date:2019-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5012563363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily