Healthcare Provider Details

I. General information

NPI: 1932174778
Provider Name (Legal Business Name): ANDREA SKAGGS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/22/2006
Last Update Date: 12/30/2020
Certification Date: 12/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1141 HOSPITAL DR NW
CORYDON IN
47112-2164
US

IV. Provider business mailing address

PO BOX 38
CORYDON IN
47112-0038
US

V. Phone/Fax

Practice location:
  • Phone: 812-738-4251
  • Fax:
Mailing address:
  • Phone: 812-738-4251
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberKY34084
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number34084
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: