MEDICARE: ANDREA FAY KEITH APRN, FNP-C

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	363LF0000X	Family Nurse Practitioner	AP137899	TX

General Provider Information

NPI Number	:	1417443060
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREA FAY KEITH APRN, FNP-C

Provider Business Mailing Address
First Line	:	17834 MAPLE ASH DR
Second Line	:
City	:	SPRING
State	:	TX
Zip	:	77379-1555
Country	:	US
Telephone Number	:	281-682-7981
Fax Number	:

Provider Business Practice Location Address
First Line	:	2829 TECHNOLOGY FOREST BLVD STE 140
Second Line	:
City	:	THE WOODLANDS
State	:	TX
Zip	:	77381-3913
Country	:	US
Telephone Number	:	281-223-1124
Fax Number	:

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

Provider Enumeration Date	:	07/06/2018
Last Update Date	:	11/01/2020

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