Provider Demographics
NPI:1871601914
Name:BABB, ANDREA K (PA-C)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:K
Last Name:BABB
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:K
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA-C
Mailing Address - Street 1:201 S HILLSIDE ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67211-2128
Mailing Address - Country:US
Mailing Address - Phone:316-682-6551
Mailing Address - Fax:316-682-8151
Practice Address - Street 1:201 S HILLSIDE ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67211-2128
Practice Address - Country:US
Practice Address - Phone:316-682-6551
Practice Address - Fax:316-682-8151
Is Sole Proprietor?:No
Enumeration Date:2006-08-28
Last Update Date:2021-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS15-01006363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSQ12153Medicare UPIN
KSQ12153Medicare UPIN
KS200253270AMedicaid
KS042551Medicare ID - Type Unspecified