Healthcare Provider Details

I. General information

NPI: 1902735624
Provider Name (Legal Business Name): EDITH GOLDEN PSS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2026
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 BROADWAY ST
PADUCAH KY
42001-0713
US

IV. Provider business mailing address

425 BROADWAY ST
PADUCAH KY
42001-0713
US

V. Phone/Fax

Practice location:
  • Phone: 270-442-7121
  • Fax: 270-443-9692
Mailing address:
  • Phone: 270-442-7121
  • Fax: 270-443-9692

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: