Healthcare Provider Details

I. General information

NPI: 1942855606
Provider Name (Legal Business Name): EDWINA LEIGH WITHROW APRN, NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2019
Last Update Date: 05/19/2022
Certification Date: 05/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

308 N KY 7
SANDY HOOK KY
41171-7134
US

IV. Provider business mailing address

PO BOX 690
BEATTYVILLE KY
41311-0690
US

V. Phone/Fax

Practice location:
  • Phone: 606-738-9785
  • Fax: 859-317-2148
Mailing address:
  • Phone: 606-464-0151
  • Fax: 606-464-0152

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3013673
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: