Provider Demographics
NPI:1609147883
Name:EDGMON, MICHELLE (FNP-BC)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:EDGMON
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51342 NATIONAL RD STE J
Mailing Address - Street 2:
Mailing Address - City:SAINT CLAIRSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43950-1700
Mailing Address - Country:US
Mailing Address - Phone:740-232-2180
Mailing Address - Fax:740-232-2182
Practice Address - Street 1:51342 NATIONAL RD STE J
Practice Address - Street 2:
Practice Address - City:SAINT CLAIRSVILLE
Practice Address - State:OH
Practice Address - Zip Code:43950-1700
Practice Address - Country:US
Practice Address - Phone:740-232-2180
Practice Address - Fax:740-232-2182
Is Sole Proprietor?:No
Enumeration Date:2012-01-20
Last Update Date:2022-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.025713363LF0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
P01213515OtherRAILROAD MEDICARE
OH0094092Medicaid
OH0094092Medicaid
P01213515OtherRAILROAD MEDICARE