Provider Demographics
NPI:1780639757
Name:EDENS, NANCY A (PA)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:A
Last Name:EDENS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2435
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:TX
Mailing Address - Zip Code:76430-8020
Mailing Address - Country:US
Mailing Address - Phone:325-762-2447
Mailing Address - Fax:
Practice Address - Street 1:2802 W WALKER ST
Practice Address - Street 2:
Practice Address - City:BRECKENRIDGE
Practice Address - State:TX
Practice Address - Zip Code:76424-4000
Practice Address - Country:US
Practice Address - Phone:254-559-7215
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2014-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA02449363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX830N91OtherBCBS
TXP01105608OtherRAILROAD MEDICARE
TX219383101Medicaid
TX8N9828OtherBCBS FAMILY PRACTICE
TX830N91OtherBCBS
TX219383101Medicaid