Provider Demographics
NPI:1609542745
Name:EDDY, KIMBER LEIGH
Entity Type:Individual
Prefix:
First Name:KIMBER
Middle Name:LEIGH
Last Name:EDDY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KIMBER
Other - Middle Name:LEIGH
Other - Last Name:BOORD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:58 16TH ST #500
Mailing Address - Street 2:
Mailing Address - City:WHEELING
Mailing Address - State:WV
Mailing Address - Zip Code:26003
Mailing Address - Country:US
Mailing Address - Phone:740-632-2450
Mailing Address - Fax:
Practice Address - Street 1:58 16TH ST #500
Practice Address - Street 2:
Practice Address - City:WHEELING
Practice Address - State:WV
Practice Address - Zip Code:26003
Practice Address - Country:US
Practice Address - Phone:304-242-7751
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-18
Last Update Date:2022-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.0029579363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care