Provider Demographics
NPI:1518271899
Name:TAPLEY, EDWINA DIANE (APRN)
Entity Type:Individual
Prefix:
First Name:EDWINA
Middle Name:DIANE
Last Name:TAPLEY
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 1:7250 HWY 44
Mailing Address - Street 2:
Mailing Address - City:UNCLE SAM
Mailing Address - State:LA
Mailing Address - Zip Code:70792
Mailing Address - Country:US
Mailing Address - Phone:859-585-0338
Mailing Address - Fax:
Practice Address - Street 1:7250 HWY 44
Practice Address - Street 2:
Practice Address - City:UNCLE SAM
Practice Address - State:LA
Practice Address - Zip Code:70792
Practice Address - Country:US
Practice Address - Phone:225-474-4102
Practice Address - Fax:225-474-4093
Is Sole Proprietor?:No
Enumeration Date:2010-07-29
Last Update Date:2016-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3006553363LF0000X
LAAP08090363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100137560Medicaid
KY0379Medicare PIN