Healthcare Provider Details

I. General information

NPI: 1396266037
Provider Name (Legal Business Name): KATIE JO EDMAN FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2017
Last Update Date: 04/21/2022
Certification Date: 04/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 ROSEMAR CIR
PARKERSBURG WV
26104-1219
US

IV. Provider business mailing address

4 ROSEMAR CIR
PARKERSBURG WV
26104-1219
US

V. Phone/Fax

Practice location:
  • Phone: 304-865-5130
  • Fax: 304-485-1519
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number83752
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: