Basic Information
| Provider Information | |||||||||
| NPI: | 1639560055 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | DELL | ||||||||
| FirstName: | ANDREW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5818 COVEY LN | ||||||||
| Address2: | |||||||||
| City: | TYLER | ||||||||
| State: | TX | ||||||||
| PostalCode: | 757034501 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6158918407 | ||||||||
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| Practice Location | |||||||||
| Address1: | 8080 E CENTRAL AVE | ||||||||
| Address2: | SUITE 250 | ||||||||
| City: | WICHITA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 672062368 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3166867327 | ||||||||
| FaxNumber: | 3166861557 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/06/2015 | ||||||||
| LastUpdateDate: | 10/11/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 10/11/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | AP128139 | TX | N | Allopathic & Osteopathic Physicians | Anesthesiology | 367500000X | 557317 | KS | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered | 367500000X | AP128139 | TX | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
ID Information
| ID | Type | State | Issuer | Description | P01536077 | 01 | TX | RAIL ROAD | OTHER | 351031501 | 05 | TX | MEDICAID | 75-0818167-015 | 01 | TX | TRICARE | OTHER |