Provider Demographics
NPI:1942855606
Name:WITHROW, EDWINA LEIGH (APRN, NP-C)
Entity Type:Individual
Prefix:MRS
First Name:EDWINA
Middle Name:LEIGH
Last Name:WITHROW
Suffix:
Gender:F
Credentials:APRN, NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 690
Mailing Address - Street 2:
Mailing Address - City:BEATTYVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41311-0690
Mailing Address - Country:US
Mailing Address - Phone:606-464-0151
Mailing Address - Fax:606-464-0152
Practice Address - Street 1:308 N KY 7
Practice Address - Street 2:
Practice Address - City:SANDY HOOK
Practice Address - State:KY
Practice Address - Zip Code:41171-7134
Practice Address - Country:US
Practice Address - Phone:606-738-9785
Practice Address - Fax:859-317-2148
Is Sole Proprietor?:No
Enumeration Date:2019-08-08
Last Update Date:2022-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3013673363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY3013673OtherAPRN
KY7100635070Medicaid
F07191647OtherAANP CERTIFICATION BOARD