Healthcare Provider Details

I. General information

NPI: 1326040973
Provider Name (Legal Business Name): ANDRIA JEAN HEAD PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2005
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

715 N KANSAS AVE STE 204
HASTINGS NE
68901-4438
US

IV. Provider business mailing address

715 N SAINT JOSEPH AVE
HASTINGS NE
68901-4497
US

V. Phone/Fax

Practice location:
  • Phone: 402-463-6828
  • Fax:
Mailing address:
  • Phone: 402-463-4521
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateNE
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number1317
License Number StateNE
# 3
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number01493
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: