Provider Demographics
NPI:1881446326
Name:EDDS, MICHAELA LAMAE (FNP-C)
Entity type:Individual
Prefix:
First Name:MICHAELA
Middle Name:LAMAE
Last Name:EDDS
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:616 KING RD
Mailing Address - Street 2:
Mailing Address - City:TAZEWELL
Mailing Address - State:TN
Mailing Address - Zip Code:37879-5219
Mailing Address - Country:US
Mailing Address - Phone:865-279-2444
Mailing Address - Fax:
Practice Address - Street 1:951 N BROAD ST
Practice Address - Street 2:
Practice Address - City:TAZEWELL
Practice Address - State:TN
Practice Address - Zip Code:37879-4323
Practice Address - Country:US
Practice Address - Phone:423-259-8661
Practice Address - Fax:423-259-8662
Is Sole Proprietor?:No
Enumeration Date:2024-04-05
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN36100363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily