Provider Demographics
NPI:1982426748
Name:SISSON, ANDREW WARREN (MEDICAL STUDENT)
Entity type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:WARREN
Last Name:SISSON
Suffix:
Gender:M
Credentials:MEDICAL STUDENT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2140 BONNYCASTLE AVE APT 10E
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40205-1375
Mailing Address - Country:US
Mailing Address - Phone:859-967-6577
Mailing Address - Fax:
Practice Address - Street 1:2140 BONNYCASTLE AVE APT 10E
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40205-1375
Practice Address - Country:US
Practice Address - Phone:859-967-6577
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-31
Last Update Date:2024-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program