MEDICARE: ANDREA FAULKNER NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LA2200X	Adult Health Nurse Practitioner	112131	MO

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00385458	OTHER		RAILROAD MEDICARE

General Provider Information

NPI Number	:	1043341928
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREA FAULKNER NP

Provider Business Mailing Address
First Line	:	PO BOX 843225
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64184-3225
Country	:	US
Telephone Number	:	708-633-1234
Fax Number	:	708-342-7100

Provider Business Practice Location Address
First Line	:	24 S MOUNT AUBURN RD
Second Line	:
City	:	CAPE GIRARDEAU
State	:	MO
Zip	:	63703-4914
Country	:	US
Telephone Number	:	573-331-5544
Fax Number	:	573-331-5545

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/09/2007
Last Update Date	:	10/14/2012

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