Healthcare Provider Details

I. General information

NPI: 1447708094
Provider Name (Legal Business Name): AMY JOY EADY NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMY JOY BARNABO RN

II. Dates (important events)

Enumeration Date: 09/12/2016
Last Update Date: 08/16/2025
Certification Date: 08/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3836 DEER RIDGE TRL
BEULAH MI
49617-9638
US

IV. Provider business mailing address

3836 DEER RIDGE TRL
BEULAH MI
49617-9638
US

V. Phone/Fax

Practice location:
  • Phone: 586-306-8770
  • Fax:
Mailing address:
  • Phone: 586-306-8770
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number95004918
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207QA0000X
TaxonomyAdolescent Medicine (Family Medicine) Physician
License Number95004918
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNP95004918
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95004918
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024188518
License Number StateVA
# 6
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704281115
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: