MEDICARE: EUGENE EDWARDS

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
1	363LA2100X	Acute Care Nurse Practitioner	5017459	NC
2	146L00000X	Paramedic	M0956578

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	250554	OTHER	NC	NURSE
2	M0956578	OTHER		NATIONAL REGISTRY

General Provider Information

NPI Number	:	1255067898
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EUGENE EDWARDS

Provider Business Mailing Address
First Line	:	PO BOX 446
Second Line	:
City	:	NEBO
State	:	NC
Zip	:	28761-0004
Country	:	US
Telephone Number	:	828-925-1696
Fax Number	:

Provider Business Practice Location Address
First Line	:	152 E FOREST DR
Second Line	:
City	:	NEBO
State	:	NC
Zip	:	28761-9540
Country	:	US
Telephone Number	:	828-925-1696
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/26/2022
Last Update Date	:	02/12/2023

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Directions to “ EUGENE EDWARDS ” Practice Location

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