| Provider / Organization | NPI | Date Certified |
|---|---|---|
| ANDREA MARIE MCCULLOCH | 1316405905 | 2022-08-07 |
Andrea Marie Mcculloch [F] graduated in 2018 and primarily specializes in Nurse Practitioner.
Andrea Marie Mcculloch is registered with the National Plan and Provider Enumeration System and has been issued an National Provider Identifier (NPI) of 1316405905. Registration indicates Andrea Marie Mcculloch is a provider of access to adult/geriatric primary care providers services with a specialization in Physician Assistants & Advanced Practice Nursing Providers, Nurse Practitioner Access to Pediatric Primary Care Providers (Physician Assistants & Advanced Practice Nursing Providers, Nurse Practitioner) (Physician Assistants & Advanced Practice Nursing Providers, Nurse Practitioner) (Nurse Practitioner, ) (All Other Specialties & Provider Types, ) (Nurse Practitioner, Physician Assistants & Advanced Practice Nursing Providers) Access to Adult/Geriatric Primary Care Providers (Physician Assistants & Advanced Practice Nursing Providers, Nurse Practitioner) (Physician Assistants & Advanced Practice Nursing Providers, Nurse Practitioner) (Nurse Practitioner: Gerontology, ) (All Other Specialties & Provider Types, ) (Nurse Practitioner Gerontology, Physician Assistants & Advanced Practice Nursing Providers) (Nurse Practitioner, ) Access to Adult/Geriatric Primary Care Providers (Physician Assistants & Advanced Practice Nursing Providers, Nurse Practitioner) Access to Pediatric Primary Care Providers (Physician Assistants & Advanced Practice Nursing Providers, Nurse Practitioner) (Physician Assistants & Advanced Practice Nursing Providers, Nurse Practitioner) (Nurse Practitioner: Acute Care, ) (All Other Specialties & Provider Types, ) (Nurse Practitioner Acute Care, Physician Assistants & Advanced Practice Nursing Providers) (Nurse Practitioner, )
| PECOS ID | 2062755838 |
| Registration | PART-B:Y DME:Y HHA:Y PMD:Y |
| Entity Type | Individual |
| Provider Name | Mrs. Andrea Marie Mcculloch MSN, RN, AGACNP-BC |
| Other Provider Name | Andrea Marie Allen |
| Practice Office Address | 4420 LAKE BOONE TRL RALEIGH, NC US |
| Practice Office Telephone | 7347406085 |
| Mailing Address | 401 W HARGETT ST APT 728 RALEIGH, NC 276034082 US |
| Business Telephone | 7347406085 |
| Direct Messaging Address [CDA/CCD/TXT] | [email protected] | Direct |
| Code | Practice | License No State |
|---|---|---|
| 363L00000X | Access to Adult/Geriatric Primary Care Providers Physician Assistants & Advanced Practice Nursing Providers Nurse PractitionerAccess to Pediatric Primary Care Providers Physician Assistants & Advanced Practice Nursing Providers Nurse Practitioner Physician Assistants & Advanced Practice Nursing Providers Nurse Practitioner Nurse Practitioner All Other Specialties & Provider Types Nurse Practitioner Physician Assistants & Advanced Practice Nursing Providers | ALLE-FVSF53
NC |
| 363LG0600X | Access to Adult/Geriatric Primary Care Providers Physician Assistants & Advanced Practice Nursing Providers Nurse Practitioner Physician Assistants & Advanced Practice Nursing Providers Nurse Practitioner Nurse Practitioner: Gerontology All Other Specialties & Provider Types Nurse Practitioner Gerontology Physician Assistants & Advanced Practice Nursing Providers Nurse Practitioner | 5011544
NC |
| 363LA2100X PRIMARY | Access to Adult/Geriatric Primary Care Providers Physician Assistants & Advanced Practice Nursing Providers Nurse PractitionerAccess to Pediatric Primary Care Providers Physician Assistants & Advanced Practice Nursing Providers Nurse Practitioner Physician Assistants & Advanced Practice Nursing Providers Nurse Practitioner Nurse Practitioner: Acute Care All Other Specialties & Provider Types Nurse Practitioner Acute Care Physician Assistants & Advanced Practice Nursing Providers Nurse Practitioner | 5011544
NC |