Specialty |
Taxonomy Code | Specialty Code | Provider Type | |
Primary Care |
363LP2300X | 50 | Nurse Practitioner | |
Adult Health |
363LA2200X | 50 | Nurse Practitioner | |
Family |
363LF0000X | 50 | Nurse Practitioner |
| NPI # | 1205634649 |
| LBN Legal business name | EDEN MEDICAL ASSOCIATES, LLC |
| Authorized official | MEGAN HATHCOAT - (NURSE PRACTITIONER) |
| Entity | Organization |
| Organization subpart 1 | No |
| Enumeration date | 03/03/2025 |
| Last updated | 03/03/2025 - More than a year ago |
| Identifiers | n/a |
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