Provider Demographics
NPI:1922868769
Name:EADDY, AMBER JOY (LPN)
Entity Type:Individual
Prefix:MRS
First Name:AMBER
Middle Name:JOY
Last Name:EADDY
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 COVERT CT
Mailing Address - Street 2:
Mailing Address - City:ELGIN
Mailing Address - State:SC
Mailing Address - Zip Code:29045-9854
Mailing Address - Country:US
Mailing Address - Phone:757-803-5545
Mailing Address - Fax:
Practice Address - Street 1:9 COVERT CT
Practice Address - Street 2:
Practice Address - City:ELGIN
Practice Address - State:SC
Practice Address - Zip Code:29045-9854
Practice Address - Country:US
Practice Address - Phone:757-803-5545
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-20
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC52752164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse