Healthcare Provider Details

I. General information

NPI: 1164046918
Provider Name (Legal Business Name): ANDREA NICOLE MCKERRELL OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2020
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1409 ROUTE 739
DINGMANS FERRY PA
18328-3478
US

IV. Provider business mailing address

3319 LAKE ARIEL HWY
HONESDALE PA
18431-1174
US

V. Phone/Fax

Practice location:
  • Phone: 570-686-1102
  • Fax:
Mailing address:
  • Phone: 570-253-6551
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOEG003957
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberTUV009311
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: