Healthcare Provider Details

I. General information

NPI: 1154716280
Provider Name (Legal Business Name): ANDREA BAZZELL MSN, APRN, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/06/2015
Last Update Date: 12/10/2020
Certification Date: 12/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 MEDICAL CENTER DR SUITE 101
PADUCAH KY
42003-7914
US

IV. Provider business mailing address

225 MEDICAL CENTER DR SUITE 101
PADUCAH KY
42003-7914
US

V. Phone/Fax

Practice location:
  • Phone: 270-441-4357
  • Fax:
Mailing address:
  • Phone: 270-441-4357
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3009330
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: