MEDICARE: AMY L EDDY NP

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	363LF0000X	Family Nurse Practitioner	41625	WV
2	363LF0000X	Family Nurse Practitioner	COA.06500-NP	OH

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	000000609675	OTHER	OH	ANTHEM

General Provider Information

NPI Number	:	1548220486
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMY L EDDY NP

Provider Business Mailing Address
First Line	:	416 COLEGATE DR BLDG 3
Second Line	:
City	:	MARIETTA
State	:	OH
Zip	:	45750-9549
Country	:	US
Telephone Number	:	740-568-4814
Fax Number	:	740-374-3165

Provider Business Practice Location Address
First Line	:	807 FARSON ST STE 210
Second Line	:
City	:	BELPRE
State	:	OH
Zip	:	45714-1069
Country	:	US
Telephone Number	:	740-376-5000
Fax Number	:

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

Provider Enumeration Date	:	03/24/2006
Last Update Date	:	05/01/2024

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Directions to “ AMY L EDDY NP” Practice Location

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