Provider Demographics
NPI:1548220486
Name:EDDY, AMY L (NP)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:L
Last Name:EDDY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:416 COLEGATE DR BLDG 3
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:OH
Mailing Address - Zip Code:45750-9549
Mailing Address - Country:US
Mailing Address - Phone:740-568-4814
Mailing Address - Fax:740-374-3165
Practice Address - Street 1:807 FARSON ST STE 116
Practice Address - Street 2:
Practice Address - City:BELPRE
Practice Address - State:OH
Practice Address - Zip Code:45714-1068
Practice Address - Country:US
Practice Address - Phone:740-376-1960
Practice Address - Fax:740-376-5037
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-24
Last Update Date:2021-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA.06500-NP363LF0000X
WV41625363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2258766Medicaid
OH000000609675OtherANTHEM
WV7101061000Medicaid
P28615Medicare UPIN
OH2258766Medicaid
WVNP07764Medicare PIN
OHH113370Medicare PIN