Provider Demographics
NPI:1346856366
Name:EDGMON, ERIN (APRN)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:
Last Name:EDGMON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1060
Mailing Address - Street 2:
Mailing Address - City:MARSHALL
Mailing Address - State:AR
Mailing Address - Zip Code:72650-1060
Mailing Address - Country:US
Mailing Address - Phone:870-448-5733
Mailing Address - Fax:870-448-3767
Practice Address - Street 1:BOSTON MOUNTAIN RURAL HEALTH CENTER INC.
Practice Address - Street 2:609 W CLARK ST
Practice Address - City:JASPER
Practice Address - State:AR
Practice Address - Zip Code:72641-0130
Practice Address - Country:US
Practice Address - Phone:870-446-2225
Practice Address - Fax:870-446-2227
Is Sole Proprietor?:No
Enumeration Date:2020-09-16
Last Update Date:2021-07-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AR212623363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR254276758Medicaid