Healthcare Provider Details

I. General information

NPI: 1316479678
Provider Name (Legal Business Name): ANDREA NICOLE HETHERINGTON FNPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ANDREA NICOLE HENSLEY FNPC

II. Dates (important events)

Enumeration Date: 03/28/2017
Last Update Date: 06/01/2023
Certification Date: 06/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 N STATE OF FRANKLIN RD FL 1
JOHNSON CITY TN
37604-6056
US

IV. Provider business mailing address

PO BOX 699
MOUNTAIN HOME TN
37684-0699
US

V. Phone/Fax

Practice location:
  • Phone: 423-439-7272
  • Fax: 423-439-7235
Mailing address:
  • Phone: 423-439-7272
  • Fax: 423-439-7235

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License NumberNP22451
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number501084
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: