Healthcare Provider Details

I. General information

NPI: 1750797213
Provider Name (Legal Business Name): ANDREA TOOLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2014
Last Update Date: 01/20/2026
Certification Date: 01/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1130 LONE OAK RD
PADUCAH KY
42003-4525
US

IV. Provider business mailing address

1130 LONE OAK RD
PADUCAH KY
42003-4525
US

V. Phone/Fax

Practice location:
  • Phone: 270-415-0245
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number61237
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code207WX0200X
TaxonomyOphthalmic Plastic and Reconstructive Surgery Physician
License Number61237
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: