Healthcare Provider Details

I. General information

NPI: 1023532983
Provider Name (Legal Business Name): ANDREA H. MARVEL APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANDREA H. GAY APRN

II. Dates (important events)

Enumeration Date: 08/01/2017
Last Update Date: 10/29/2024
Certification Date: 10/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 SUNSET DRIVE
CANEYVILLE KY
42721
US

IV. Provider business mailing address

PO BOX 23229
OWENSBORO KY
42304-3229
US

V. Phone/Fax

Practice location:
  • Phone: 270-879-3711
  • Fax:
Mailing address:
  • Phone: 270-688-1330
  • Fax: 270-688-1338

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number28238245A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: