Provider Demographics
NPI:1679070536
Name:EADS, LYDIA A (DNP)
Entity Type:Individual
Prefix:
First Name:LYDIA
Middle Name:A
Last Name:EADS
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:702 CAPITAL AVE. SUITE 40B
Mailing Address - Street 2:
Mailing Address - City:FRANKFORT
Mailing Address - State:KY
Mailing Address - Zip Code:40601
Mailing Address - Country:US
Mailing Address - Phone:502-564-3333
Mailing Address - Fax:502-226-7009
Practice Address - Street 1:702 CAPITAL AVE. SUITE 40B
Practice Address - Street 2:
Practice Address - City:FRANKFORT
Practice Address - State:KY
Practice Address - Zip Code:40601
Practice Address - Country:US
Practice Address - Phone:502-564-3333
Practice Address - Fax:502-226-7009
Is Sole Proprietor?:No
Enumeration Date:2018-04-09
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3012142363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner