1396964102 NPI number — MRS. EVA ANGEL EDWARDS APRN,FNP-BC,RFNA,CNO

Table of content: MRS. EVA ANGEL EDWARDS APRN,FNP-BC,RFNA,CNO (NPI 1396964102)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396964102 NPI number — MRS. EVA ANGEL EDWARDS APRN,FNP-BC,RFNA,CNO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
EDWARDS
Provider First Name:
EVA
Provider Middle Name:
ANGEL
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
APRN,FNP-BC,RFNA,CNO
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1396964102
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/19/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
204 TOWN BRANCH RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MANCHESTER
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40962-1322
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
606-598-8766
Provider Business Mailing Address Fax Number:
606-598-1903

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
204 TOWN BRANCH RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MANCHESTER
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40962
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-598-8766
Provider Business Practice Location Address Fax Number:
606-598-1903
Provider Enumeration Date:
04/24/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 163W00000X , with the licence number:  1090669 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 163WR0006X , with the licence number: CEP11471 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363L00000X , with the licence number: 3010637 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LP0808X , with the licence number: 3010637 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X , with the licence number: 3010637 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 474730776 . This is a "FAMILY PRACTICE OF KENTUCKY LLC" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 611341461 . This is a "EDWARDS CLINIC PSC" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 611341461 . This is a "EDWARDS CLINIC PSC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0000000280746 . This is a "BCBS" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 7100423770 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".