Healthcare Provider Details

I. General information

NPI: 1932437589
Provider Name (Legal Business Name): ANDREW KENT BADER PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: ANDREW KENT BADER DC

II. Dates (important events)

Enumeration Date: 11/19/2009
Last Update Date: 11/28/2022
Certification Date: 11/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

705 HIGHWAY 446
NIXON NV
89424
US

IV. Provider business mailing address

PO BOX 227
NIXON NV
89424-0227
US

V. Phone/Fax

Practice location:
  • Phone: 775-574-1018
  • Fax: 775-574-1028
Mailing address:
  • Phone: 775-574-1018
  • Fax: 775-574-1028

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111NI0013X
TaxonomyIndependent Medical Examiner Chiropractor
License NumberB0998
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA2013
License Number StateNV
# 3
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA0386
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: