Provider Demographics
NPI:1780643585
Name:EDELEN, DEBORAH (ARNP)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:
Last Name:EDELEN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 N CAMP DICK RD
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:KY
Mailing Address - Zip Code:40444-6301
Mailing Address - Country:US
Mailing Address - Phone:859-548-8000
Mailing Address - Fax:859-548-8030
Practice Address - Street 1:510 N CAMP DICK RD
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:KY
Practice Address - Zip Code:40444-6301
Practice Address - Country:US
Practice Address - Phone:859-548-8000
Practice Address - Fax:859-548-8030
Is Sole Proprietor?:No
Enumeration Date:2006-03-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3003219363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY78004124Medicaid
KYP14137Medicare UPIN