Healthcare Provider Details

I. General information

NPI: 1497497432
Provider Name (Legal Business Name): JAMES ALLEN EDGINGTON DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/11/2022
Last Update Date: 08/14/2025
Certification Date: 08/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 W COMMERCIAL ST
KENNETT MO
63857-1100
US

IV. Provider business mailing address

901 W COMMERCIAL ST
KENNETT MO
63857-1100
US

V. Phone/Fax

Practice location:
  • Phone: 573-717-1072
  • Fax:
Mailing address:
  • Phone: 573-717-1072
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2025026432
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: