Provider Demographics
NPI:1376590562
Name:EDDY, MARTHA E (APRN)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:E
Last Name:EDDY
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2469
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40201-2469
Mailing Address - Country:US
Mailing Address - Phone:502-852-8500
Mailing Address - Fax:502-852-8556
Practice Address - Street 1:234 E GRAY ST
Practice Address - Street 2:SUITE 270
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-1903
Practice Address - Country:US
Practice Address - Phone:502-629-8830
Practice Address - Fax:502-629-7540
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2012-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3001550363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200803070Medicaid
IN200803070Medicaid