Provider Demographics
NPI:1336845346
Name:EDDY, AMBER (AGNP)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:
Last Name:EDDY
Suffix:
Gender:F
Credentials:AGNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:926 SIBLEY RD
Mailing Address - Street 2:
Mailing Address - City:LUMBERTON
Mailing Address - State:NC
Mailing Address - Zip Code:28358-6009
Mailing Address - Country:US
Mailing Address - Phone:910-416-3168
Mailing Address - Fax:
Practice Address - Street 1:1003 WOODRIDGE DR
Practice Address - Street 2:
Practice Address - City:LUMBERTON
Practice Address - State:NC
Practice Address - Zip Code:28358-3328
Practice Address - Country:US
Practice Address - Phone:910-250-5100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-01
Last Update Date:2023-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCAG01230059363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health