Provider Demographics
NPI:1164144937
Name:VILLIARD, EDEN MARIE (FNP)
Entity Type:Individual
Prefix:MRS
First Name:EDEN
Middle Name:MARIE
Last Name:VILLIARD
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:133 BOONE RIDGE DR APT 79
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37615-5008
Mailing Address - Country:US
Mailing Address - Phone:276-220-0678
Mailing Address - Fax:
Practice Address - Street 1:6419 BRISTOL HWY
Practice Address - Street 2:
Practice Address - City:PINEY FLATS
Practice Address - State:TN
Practice Address - Zip Code:37686-5208
Practice Address - Country:US
Practice Address - Phone:423-538-5202
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-16
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN32491363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care