Provider Demographics
NPI:1396964102
Name:EDWARDS, EVA ANGEL (APRN,FNP-BC,RFNA,CNO)
Entity type:Individual
Prefix:MRS
First Name:EVA
Middle Name:ANGEL
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:APRN,FNP-BC,RFNA,CNO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 TOWN BRANCH RD
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:KY
Mailing Address - Zip Code:40962-1322
Mailing Address - Country:US
Mailing Address - Phone:606-598-8766
Mailing Address - Fax:606-598-1903
Practice Address - Street 1:204 TOWN BRANCH RD
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:KY
Practice Address - Zip Code:40962
Practice Address - Country:US
Practice Address - Phone:606-598-8766
Practice Address - Fax:606-598-1903
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2022-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1090669163W00000X
KYCEP11471163WR0006X
KY3010637363L00000X, 363LP0808X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
No163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY474730776OtherFAMILY PRACTICE OF KENTUCKY LLC
KY611341461OtherEDWARDS CLINIC PSC
611341461OtherEDWARDS CLINIC PSC
KY0000000280746OtherBCBS
KY7100423770Medicaid
KY0000000280746OtherBCBS