Healthcare Provider Details

I. General information

NPI: 1376295196
Provider Name (Legal Business Name): ANDREA FARRELL NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2022
Last Update Date: 09/13/2023
Certification Date: 09/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7500 WINDROSE AVE STE B192
PLANO TX
75024-0163
US

IV. Provider business mailing address

604 EVERGREEN RD
AUBREY TX
76227-4576
US

V. Phone/Fax

Practice location:
  • Phone: 469-915-6863
  • Fax:
Mailing address:
  • Phone: 407-314-9172
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number1068389
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: