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General NPI Number Information
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NPI Number | 1821866401
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Entity Type | Individual
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Provider Name | ANDREA D DEMARIA PMHNP-BC
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Gender | Female
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Dates
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Enumeration Date | 12/13/2023
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Last Update Date | 01/13/2025
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Provider Practice Location Address
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Address Line | 95 S LAUREL RD STE 1
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City | LONDON
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State | KY
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Zip | 40744-8300
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Country | US
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Telephone | 606-770-5086
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Fax | 863-456-1301
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Provider Business Mailing Address
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Address Line | 95 S LAUREL RD STE 1
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City | LONDON
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State | KY
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Zip | 40744-8300
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Country | US
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Telephone | 606-770-5086
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Fax | 863-456-1301
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WP0808X
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Taxonomy Name | Psychiatric/Mental Health Registered Nurse
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License Number | RN0000200386
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 36635
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License Number State | TN
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Taxonomy #3
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 4025009
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License Number State | KY
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