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NPI Code Detail

MEDICARE: HEATHER EDMISTON LPN

MEDICARE: HEATHER EDMISTON LPN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1164W00000XLicensed Practical Nurse25723WV

General Provider Information

NPI Number : 1124243332
Entity Type Code : Individual
Provider Name (Legal Business Name) : HEATHER EDMISTON LPN
Provider Business Mailing Address
First Line : PO BOX 166
Second Line :
City : MC ANDREWS
State : KY
Zip : 41543-0166
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1609 W 3RD AVE
Second Line :
City : WILLIAMSON
State : WV
Zip : 25661-3006
Country : US
Telephone Number : 304-235-0026
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/14/2007
Last Update Date : 07/08/2007

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Directions to “ HEATHER EDMISTON LPN” Practice Location

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