Provider Demographics
NPI:1659884237
Name:EDENFIELD, RACHEL OGLESBY (PNP)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:OGLESBY
Last Name:EDENFIELD
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:450 GEORGIA AVE STE A
Mailing Address - Street 2:
Mailing Address - City:STATESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30458-5590
Mailing Address - Country:US
Mailing Address - Phone:912-489-3325
Mailing Address - Fax:
Practice Address - Street 1:450 GEORGIA AVE STE A
Practice Address - Street 2:
Practice Address - City:STATESBORO
Practice Address - State:GA
Practice Address - Zip Code:30458-5590
Practice Address - Country:US
Practice Address - Phone:912-489-3325
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-06
Last Update Date:2021-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN227704363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics