Healthcare Provider Details

I. General information

NPI: 1851814057
Provider Name (Legal Business Name): ANDIE E MALDONADO PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANDIE E MEADE PA-C

II. Dates (important events)

Enumeration Date: 07/19/2017
Last Update Date: 07/21/2022
Certification Date: 08/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7501 QUAKER AVE
LUBBOCK TX
79424-3367
US

IV. Provider business mailing address

5219 CITY BANK PKWY STE 35
LUBBOCK TX
79407-3545
US

V. Phone/Fax

Practice location:
  • Phone: 806-788-3306
  • Fax: 806-722-3861
Mailing address:
  • Phone: 806-761-0333
  • Fax: 806-782-0097

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number2098
License Number StateWV
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA13717
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: