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General NPI Number Information
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NPI Number | 1881077717
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Entity Type | Individual
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Provider Name | WALTER BRADLEY EDINGTON NP
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Gender | Male
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Dates
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Enumeration Date | 07/09/2015
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Last Update Date | 12/08/2023
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Provider Practice Location Address
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Address Line | 140 BURKE CALHOUN CITY RD
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City | CALHOUN CITY
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State | MS
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Zip | 38916-9690
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Country | US
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Telephone | 662-628-6611
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Fax | 662-628-6300
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Provider Business Mailing Address
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Address Line | 965 RIDGE LAKE BLVD STE 315
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City | MEMPHIS
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State | TN
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Zip | 38120-9401
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 864373
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License Number State | MS
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