MEDICARE: EDALYN SHAW

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	4035097	KY

General Provider Information

NPI Number	:	1134924459
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EDALYN SHAW

Provider Business Mailing Address
First Line	:	PO BOX 306414
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37230-6414
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1475 NASHVILLE RD
Second Line	:
City	:	FRANKLIN
State	:	KY
Zip	:	42134-6961
Country	:	US
Telephone Number	:	270-813-1111
Fax Number	:

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

Provider Enumeration Date	:	02/19/2025
Last Update Date	:	02/19/2025

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Directions to “ EDALYN SHAW ” Practice Location

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