Healthcare Provider Details

I. General information

NPI: 1477544872
Provider Name (Legal Business Name): DEBRA J EADENS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/03/2005
Last Update Date: 06/12/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

402 BOGLE ST STE 3
SOMERSET KY
42503-2870
US

IV. Provider business mailing address

402 BOGLE ST STE 3
SOMERSET KY
42503-2870
US

V. Phone/Fax

Practice location:
  • Phone: 606-451-9953
  • Fax: 606-451-1533
Mailing address:
  • Phone: 606-451-9953
  • Fax: 606-451-1533

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number29813
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: