MEDICARE: MARTHA E. EDDY APRN

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	363LP0200X	Pediatric Nurse Practitioner	3001550	KY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1376590562
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARTHA E. EDDY APRN

Provider Business Mailing Address
First Line	:	PO BOX 2469
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40201-2469
Country	:	US
Telephone Number	:	502-852-8500
Fax Number	:	502-852-8556

Provider Business Practice Location Address
First Line	:	234 E GRAY ST
Second Line	:	SUITE 270
City	:	LOUISVILLE
State	:	KY
Zip	:	40202-1903
Country	:	US
Telephone Number	:	502-629-8830
Fax Number	:	502-629-7540

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

Provider Enumeration Date	:	05/31/2006
Last Update Date	:	10/29/2012

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